TMJ/TMD Screening Questionnaire
Care That Goes Beyond
Tell Us About Your Jaw Symptoms
Jaw pain, clicking, headaches and ear discomfort can be linked to the jaw joint (TMJ). This screening questionnaire helps Dr. Dhol understand where you feel symptoms, how long you have had them and how they affect your day, so your exam can focus on what matters most.
Before You Start
- Think about your main concern and how long you have had it.
- Mark whether each symptom is on the left side, right side or both.
- Answer for how you usually feel, not only on your best or worst days.
Questions about this form? Call or text our South Surrey office at (604) 502-5155.