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Patient Forms

Download and print any of the forms below. Click a form to open the PDF.

Form A - Symptoms Form Form B - The Epworth Sleepiness Scale Form C - New Patient Interview Form Form D - Body Mass Index Form E - TMJ Screening Form Form F - Flags Indicating Need for Mini Phase I Exam Form G - What a Mini Phase I Is Form H - Financial Contract Form I - Head, Neck, Facial Pain & TMJ Questionnaire Form J - Financial Contract Form K - Informed Consent Form L - TMJ Dental Examination Form M - Your New Orthotic Splint Appliance Form N - TMJ Progress Report Form O - Phase I Completion Form P - TMD Phase I Final Records Form Q - Soft Food Diet Form R - Ice/Moist Heat Instructions Form S - Tongue Blade Exercises Form T - Gum Chewing Exercises Form U - Headache Diary Form V - Weaning Off & Decreasing Your Appliance Wear Form W - Phase II Prosthetic Rehabilitation Form X - Prosthodontic Consent

The Lab:

For Clients:

RX Slips & Forms

Shade Taking Guide

Symptom Screening Forms