https://static.wixstatic.com/media/a2b50a_24d135ef16c64e37956fa0a7300eddf4~mv2.png TMJ Triage Form

Is your jaw locked or unable to open? Required

Yes

No

Has your bite or the way your teeth come together changed? Required

Yes

No

Is there visible swelling on your face? Required

Yes

No

Do you experience sharp or burning pain? Required

Yes

No

Do you feel pain in your teeth? Required

Yes

No

Does pain wake you up at night? Required

Yes

No

Do you experience numbness in your head or face? Required

Yes

No

Do you experience nausea? Required

Yes

No

Do you have difficulty speaking or swallowing? Required

Yes

No

Do you experience dizziness or vertigo? Required

Yes

No

TMJ TRIAGE FORM