TMJ Questionnaire
1. In the last 30 days, which of the following best describes any pain in your jaw or temple area on either side?
No pain
Pain comes and goes
Pain is always present
2. In the last 30 days, have you had pain or stiffness in your jaw on awakening?
No
Yes
3. [Select all that apply] In the last 30 days, did the following activities change any pain (that is, make it better or make it worse) in your jaw or temple area on either side?
Chewing hard or tough food
Opening your mouth or moving your jaw forward or to the side
Jaw habits such as holding teeth together, clenching/grinding, or chewing gum
Other jaw activities such as talking, kissing, or yawning
Other
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Submit
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