TMJ & SLEEP THERAPY CENTRE OF CLEVELAND

Dr. Kristina M. Wolf, MS, DMD

5005 Rockside Rd. Suite 1225
Independence, OH 44131
Tel: 216.447.9830
Info@Cleveland TMJSleep.com
www.Cleveland TMJSleep.com

Instructions: Email or Mail a copy to TMJ & Sleep Therapy Center of Cleveland.

Screening Form

For Patients with Head, Neck and Facial Pain & Sleep-Related Breathing Disorders/ Apnea

Primary headaches or migraines

Snoring/Sleep Apnea

Disturbed, restless sleeping

CPAP Intolerance

Daytime drowsiness

Attention deficit in children

Earaches, stuffiness or ringing

Neck, shoulder, back pain or stiffness

Dizziness

Pain or soreness in TM joints

Clicking or grating sounds in TM joints

Limited mouth opening

Locking jaw (opened or closed)

Facial or undiagnosed teeth pain

Difficulty swallowing

When your patients experience one or more of these symptoms, they should have a thorough evaluation by a dentist trained in craniofacial pain (TMJ, headaches, facial pain) and sleep-related breathing disorder (sleep apnea, snoring). we will be happy to assit you in diagnosis and non-surgical treatment options for your patients with these disorder.

Patient information

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