Free TMJ Test from Lee Palmer, DDS
Please complete the test in its entirety. We will not share your information with anyone.

This is not a scientific test, nor should your results be considered medically validated. It is merely a tool to help you understand the possibility of a TMJ condition. It is advised that an experienced TMJ dentist be sought if you feel you want to pursue a professional diagnosis.

To schedule an appointment with Dr. Palmer, call our office at (615) 794-0756 or email us at leepalmerddsoffice@gmail.com.

First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Email Address
Your answer
How often do you experience headaches - including migraines? *
Have you experienced, or been told you clench or grind your teeth? *
Do you ever experience pain or tenderness in your facial area? *
Ever experience popping/clicking when opening/closing your mouth? *
Does chewing or talking cause soreness, pain or fatigue in your jaw? *
Do you ever experience unexplained ear pain or ringing sounds? *
Do you have neck or shoulder pain from an injury or auto accident? *
Do you (or been told that you) have receding gum lines? *
Is it difficult to find a comfortable bite or position for your mouth? *
Do you feel that you have limited mouth opening or movement? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Lee Palmer, DDS.