GUILDFORD ORTHODONTIC CENTRE ADULT INFORMATION

Have you had hepatitis or rheumatic fever?

Have you had any serious chronic illnesses or operations?

Are you taking any medications? Please specify in the remarks

Do you have a history of heart trouble, allergies, diabetes, asthma or arthritis? Please specify in the remarks

Do you have any of the following habits: Thumb/Finger sucking, nail biting, or mouth breathing? Please specify in the remarks

Have you had any previous blows to the mouth or teeth?

Do you have difficulty opening the mouth?

Do you hear noises from the jaw joints?

Has your jaw ever been locked or dislocated?

Do you have pain about the ears or cheeks?

Do you have pain on chewing, yawning, or opening wide?

Does your bite feel uncomfortable or unusual?

Have you ever had any injury to the jaw, head, or neck?

Have you been treated for TMJ (temperomandibular disorder)?

Is there any other health information that we should know about?

Have you had any previous orthodontic treatment?

Have you consulted with another orthodontist?