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Screening/Referral Form Frequent snoring Sleep apnea CPAP Alternative Daytime fatigue Told that I stop breathing during sleep Headache/Migraine Ear Pain, Ear Stuffiness Tinnitus Pain behind the eyes
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How to fill out screeningreferral form - tmj
How to fill out screeningreferral form - tmj:
01
Start by carefully reading the instructions on the form. This will give you an overview of the information that needs to be provided.
02
Begin filling in your personal details in the appropriate sections of the form. This may include your full name, date of birth, address, and contact information.
03
Move on to the medical history section. Fill in any relevant information pertaining to your jaw, temporomandibular joint (TMJ), or any related symptoms or conditions. Be as detailed and accurate as possible.
04
If applicable, provide information about any previous TMJ treatments or therapies you have undergone.
05
Continue by describing your specific symptoms or reasons for seeking a TMJ screening or referral. Include any relevant information about your pain or discomfort, changes in jaw movement, or any other related concerns.
06
Make sure to sign and date the form at the designated area.
07
Before submitting the form, review it to ensure all sections are completed accurately and legibly.
Who needs screeningreferral form - tmj?
01
Individuals experiencing jaw pain, discomfort, or issues related to the temporomandibular joint (TMJ).
02
People who have difficulty opening or closing their mouth fully, or have limited jaw movement.
03
Individuals who have been referred by their dentist, physician, or other healthcare professionals for further evaluation or treatment of TMJ-related concerns.
04
Those who suspect they may have TMJ disorder and want to seek a diagnosis or specialized care.
It is important to note that the exact requirements for filling out a screeningreferral form - tmj may vary depending on the specific healthcare provider or clinic. Therefore, it is always advisable to carefully read and follow the instructions provided with the form or consult with the healthcare professional who issued the form if you have any questions.
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