Follow the steps to fill out the TMJ Screening Questionnaire online.

1. Click ‘Get Form’ button to access the TMJ Screening Questionnaire Form TMJSQ and open it in your preferred online editor.
2. Begin by entering your patient information at the top of the form. Fill in your name, today’s date, date of birth, and age. Ensure to include your last name, first name, and middle initial.
3. Indicate your gender by selecting either ‘Male’ or ‘Female’ and fill in your current address details including city, state, and ZIP code. If you have lived at your current address for less than three years, please provide your previous address.
4. Next, specify how long you have resided at your current address and provide details about your employer, including their name and address.
5. Fill in your contact information, including work phone, home phone, email, and cell phone.
6. Identify the responsible party for the account if it differs from you and note your family physician’s name and address.
7. Indicate how you were referred to this treatment by filling in the ‘Referred By’ section.
8. List your chief complaints by numbering them, indicating what is most important to you regarding your condition.
9. Check any additional symptoms you may experience along with headaches, such as nausea or dizziness.
10. In the ‘History of Present Illness’ section, check all medical diagnoses that apply to you.
11. Describe the location and type of any head pain by filling in the corresponding details for duration, frequency, and severity in the provided fields.
12. On the second page of the form, draw your pain patterns using the provided key to illustrate the severity and type of pain you experience.
13. Finally, ensure to provide your signature confirming your understanding of the information shared in the questionnaire.
14. After completing all sections, you can save your changes, download, print, or share the filled-out questionnaire as needed.

Start filling out the TMJ Screening Questionnaire online today to take the first step towards managing your condition.