1. Do you have clicking/popping sound in your joint?
Yes
No
2. Do you have pain/ soreness in and around the joints?
Yes
No
3. Do you feel itching/ blockage in the ear?
Yes
No
4. Do you have ringing/ hissing/buzzing sound in the ear?
Yes
No
5. Do you have difficulty in chewing?
Yes
No
6. Do you have missing teeth?
Yes
No
7. Have you had excessive crown/bridge work?
Yes
No
8. Do you have pain in the neck/shoulder muscles?
Yes
No
9. Do you chew exclusively on one side?
Yes
No
10. Do you have headache ?
Yes
No
11. Do you have neck or shoulder pain or both ?
Yes
No
12. Do you have pain around your eyes ?
Yes
No
13. Do you have ear pain ?
Yes
No