Transcription of Headache? Ear problems? Jaw clicking? Neck …
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Headache? Ear problems? Jaw clicking? Neck …
IMPORTANT INFORMATION THE TMJ SYSTEM . PLEASE FILL OUT THIS FORM PRIOR TO YOUR DOCTOR'S. Self Evaluation Test CONSULTATION. GIVE THE COMPLETED FORM TO YOUR. DOCTOR AT YOUR NEXT VISIT. 1. Do you suffer from: HEADACHES EAR SYMPTOMS. Headaches Front of head Ear pain Jaw clicking and pain Back of head Right side Neck pain Migraines Left side Muscular stiffness Facial pain Clogged, itchy ears Facial pain Sinus pain Balance problems Ear pain Hissing, buzzing or JAW SYMPTOMS roaring sounds in 2. Test these muscles for tenderness: Clicking or popping the ears (tinnitis). jaw joints (TMJs). Right side EYE PAIN. Left side Pain behind eyes Jaw locking Blurred vision (open or closed). NECK SYMPTOMS. Grating sounds Neck pain Pain in either TMJ. Right side Lack of mobility (reduced neck Headache?)
IMPORTANT INFORMATION THE TMJ SYSTEM™ Headache? Ear problems? Jaw clicking? Neck tension? IT could bE TMJ dISordEr IMPorTANT INForMATIoN uSuAllY oNE SIdE IS MorE TENdEr
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