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Please complete the form below. This information will help us schedule your Initial Assessment with the most appropriate practitioner for your case.

Is your jaw locked or unable to open?
Has your bite or the way your teeth come together changed?
Is there visible swelling on your face?
Do you experience sharp or burning pain?
Do you feel pain in your teeth?
Does pain wake you up at night?
Do you experience numbness in your head or face?
Do you experience nausea?
Do you have difficulty speaking or swallowing?
Do you experience dizziness or vertigo?

Thank you for submitting this form!

*Required Information

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