Patient Questionnaire Forms

Orthognathic/Jaw 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 questionnaire.  Specifically, we want to know what you view as your problem as well as your goals and expectations for treatment. Please take your time, be as accurate as possible and submit to our office BEFORE your scheduled consultation.

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/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 form. We will use this to determine if we can help you. Patients with TMJ disorder or facial pain will not always require surgical therapy and will benefit from conservative therapies instead. If needed, we will refer you to an appropriate specialist to carry out these non-surgical treatments.

Once you have completed the form, please make sure to press the Complete and Send button at the bottom to 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.