• *please check all that apply

  • Are you aware of noises in the jaw joints?
  • Do your jaws feel stiff, tight or tired after eating?

  • Do you have any kind of sounds, feelings or discomfort in your ear(s)?

  • Do you have neck or shoulder discomfort?

  • Do you have bad headaches or migraines?

  • Have you had Orthodontic treatment?

  • Do you grind or clench your teeth?

  • Is stress/anxiety a problem?

  • Have you ever had a whiplash or any head and neck trauma?

  • Best time to reach you:

  • Reload
  • Should be Empty: