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.

You may fill out our secure online Orthognathic Questionnaire Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Orthognathic Surgery Questionnaire

The following 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.

You may fill out our secure online TMJ Questionnaire Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

TMJ Questionnaire

The following 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