In order to provide you a virtual consultation and assess your dental concerns, please submit your information below.
Your information will be securely sent back to our team to evaluate.
1. Do you have a grating, clicking or popping sound in either or both jaws when you chew?
2. Is your jaw painful or locked when you wake up in the morning?
3. Do you feel discomfort or muscle pain when chewing?
4. Do you have frequent headaches?
5. Do you feel neck and/or shoulder pain?
6. Do you feel pain in your ear, or near it?
7. Do you clench your teeth during the day?
8. Do you grind your teeth at night?
9. Do you have difficulty or pain, or both, when chewing, talking, or using your jaw?
10. Are you aware of noises in the jaw joints?
11. Have you had a recent injury to your head, neck, or jaw?
12. Have you previously been treated for a jaw joint problem?
Other Notes, Comments, or Questions
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