TMJ SCREENING QUESTIONNAIRE Form TMJSQ Patient Information 2026

1. Click ‘Get Form’ to open the TMJ SCREENING QUESTIONNAIRE Form TMJSQ in the editor.
2. Begin by filling out the Patient Information section. Select your title (MR, MS, MRS, DR) and enter today's date, your name, date of birth, age, and gender.
3. Provide your current address along with the city, state, and ZIP code. If you've lived there for less than three years, include your previous address as well.
4. Complete the employment details by entering your employer's name and address. Don't forget to add your work phone number and other contact information like home phone and email.
5. In the Chief Complaints section, list your symptoms in order of importance. Number them accordingly from #1 to any additional complaints.
6. Indicate any additional symptoms you experience with headaches by checking the relevant boxes provided.
7. For the History of Present Illness section, check all applicable medical diagnoses and provide details about your symptoms including location, duration, frequency, and severity using the provided key.
8. Finally, authorize the release of medical information by signing at the bottom of each page before submitting your completed form.

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