Patient Questionnaire Forms

Orthognathic Surgery Patients

We are glad you have chosen our practice to potentially address your surgical needs. In order for us to get a thorough understanding of your situation, please take the time to fill out the following forms.  Specifically, we want to know what you view as your problem as well as goals and expectations for treatment. Please take your time, be as accurate as possible and submit to our office BEFORE your scheduled consultation.

The forms are electronic (PDF) and can be filled out using Adobe Acrobat Reader.

Orthognathic Questionnaire

Save the file as your complete name and email to info@inlandempireomfs.com

TMJ/Facial Pain Patients

We are glad you have chosen our practice to potentially address your surgical needs. In order for us to get a thorough understanding of your situation, please take the time to fill out the following forms. We will use this to determine if we can help your situation. Otherwise, we will refer you to an appropriate specialist.

The forms are electronic (PDF) and can be filled out using Adobe Acrobat Reader.

Download TMJ Questionnaire

Save the file as your complete name and email to info@inlandempireomfs.com