Does your TMJ or jaw joint hurt in the morning?:YesNo

Do you have morning headaches?:YesNo

Does your jaw ever lock open or closed?:YesNo

Do you clench or grind your teeth?:YesNo

Do you have any problem opening your mouth widely?:YesNo

Do you have ear fullness or ringing?:YesNo

Do you have or ever had high blood pressure?:YesNo

Do you ever have migraine headaches?:YesNo

Are you a restless sleeper?:YesNo

Do you wake up tired and unrefreshed?:YesNo