Name:^*

1. I experience pain or discomfort in my jaw when I talk, chew, or yawn.^*

2. I hear clicking, popping, or grinding sounds when I open or close my mouth.^*

3. I experience tension or pain in my neck, shoulders, or upper back.^*

4. I wake up with headaches or pain in my jaw.^*

5. I have difficulty opening my mouth wide or feel a restriction when opening/closing my mouth.^*

6. I clench or grind my teeth, especially at night.^*

7. I feel my bite has changed, or my teeth don’t fit together like they used to.^*

8. I feel pain or pressure behind my eyes or in my temples.^*

9. I have ringing in my ears (tinnitus) or experience earaches.^*

10. I experience pain or discomfort after chewing for a prolonged period.^*

We would like to send you the results and video resources related to your TMJ health. Could you please privide us with your email address?