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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

 

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