Getting Started
Welcome!
Please read this section before you click the link to complete our online questionnaire.
The new patient form is not phone-friendly. Please work from a 12” diagonal screen or larger; use a keyboard that you like to use; and have a mouse for dragging graphic elements. Dr. Scott needs details before we can schedule the consultation appointment. A complete medical history and details of the current problem documented in the questionnaire will make the consultation more productive and interactive.
You may have symptoms you did not know may be related to chewing and TMJ problems. Ear symptoms may include earache and ear pain, muffled hearing, dizziness (vertigo), or balance problems. The ear canals and sensitive hearing anatomy are just behind the TM joint sockets on the opposite side of the same bone.
The jaw joints are just behind and below the eyes, sinuses, and a facial nerve bundle. As jaw joint inflammation builds up, various chronic symptoms may develop in these areas. In general, check any of the listed problems from your past or present health. If you have additional information, add that to any text box in the form and we will put it in the right place.
Twelve sets of muscles position and move the lower jaw or mandible. Muscles extend to the top of the head and down through the shoulders. Any muscle in the face, head, neck, and shoulders may develop tension or pain. Muscles seem to stay contracted to brace unstable chewing systems.
We have many questions about accidents and head trauma, sometimes, we repeat questions. Accidents are easy to forget over time. It helps to review your past by decade, addresses, schools, sports, or jobs. Note childhood accidents, falls, strikes to the jaw or face, and any accident that caused bruising or stitches on your upper body. We also ask about your general health.
Page ten of the questionnaire takes extra time. Here, you will show Dr. Scott exactly where the pain is located, the size of the area, the degree of pain from mild, moderate, to severe, and the type of pain from the list like "S" for “sharp" or “T” for tightness.
Page ten will take extra time if you have or have had pain. Slow down here. Read the short instructions, and then practice. Page ten is all drag and drop.
First, put the pointer on an item in the lists. Click the mouse button once and release the mouse button. Do not click and hold the mouse button: Point, click once, and release the button.
Second, move the mouse pointer and you will see the item dangling from the pointer. It goes wherever the pointer goes until you click the button again to drop (place) it on the human outline.
Third, click the button once and RELEASE the mouse button. The item will drop and stick to the human form. Use “Undo” if you don’t like the position. You will have to reattach the item.
Repeat these three steps as many times as you need. Please work to provide details!
The color blocks do three things. They show pain intensity, the location of the pain, and the total area of pain. Drop as many color blocks as needed to show the entire area of a particular pain. Remember to DROP LETTERS just outside the pain areas to indicate the type of pain; for instance, place a letter “P” for pressure.
Practice and then click “clear page.” Now, you can show Dr. Scott graphicly without having to draw the details of the pain you may be having.
If this diagram just does not work for you, draw a diagram similar to the one on the screen and bring it with you to the consultation.
When you get to page 11, you can go back and add or make changes to any page in the form. Again, feel free to enter any text in any text box. We will move it around as needed. When you are satisfied with the entire questionnaire, go to page 11 and keep clicking until you click "Submit Form."
The time you spend on this form will give you more time in the consultation to ask questions and discuss.
If you decide not to complete the form, just close the tab or the browser. No information will be recorded, kept, or saved on your computer or sent to Dr. Scott.
Dr. Scott reviews your questionnaire the day she receives it and again just before your appointment. This form provides an orientation to your story. This allows her to ask specific questions, not general questions. This makes your face-to-face consultation more productive and interactive.
Plan to spend an hour, at least, on the questionnaire. Pick a time when you least likely be interrupted. After Dr. Scott has reviewed your questionnaire, we will contact you to schedule.
You can come back to this page anytime to review. Thanks for taking the time to read and consider these notes. Click the link below to get started, or copy and paste the link into your browser.
TEXT: 615 476 4193
EMAIL: [email protected].
Sincerely,
Steve Roberts
Administrator for Dr. Cheryl Ann Scott