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Jaws physical therapy logo in spring lake

Please Fill Out Our Patient Intake Form

Birthday
Month
Day
Year
Do you experience pain while eating or chewing?
Yes
No
Do you clench or grind your teeth, especially at night?

Click all that apply

Do you experience difficulty in opening or closing your mouth?

Click all that apply

Do you have difficulty speaking or swallowing?
Yes
No
Do you experience headaches along with your jaw pain?
Do you have neck pain or stiffness?
Yes
No
Do you experience ear pain or ringing in your ears (tinnitus)?
Yes
No
Do you have any facial muscle tenderness or fatigue?
Yes
No
Do you have a high-stress lifestyle or experience frequent stress?
Yes
No
Other

Thank you for taking the time to complete this questionnaire. Your responses will help us create a personalized treatment plan to address your jaw pain and improve your overall function and well-being

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Accessibility Statement for Jaws Physical Therapy

This is an accessibility statement from Jaws Physical Therapy .

Conformance status

The Web Content Accessibility Guidelines (WCAG) defines requirements for designers and developers to improve accessibility for people with disabilities. It defines three levels of conformance: Level A, Level AA, and Level AAA. Jaws Physical Therapy is partially conformant with WCAG 2.1 level AA. Partially conformant means that some parts of the content do not fully conform to the accessibility standard.

Feedback

We welcome your feedback on the accessibility of Jaws Physical Therapy. Please let us know if you encounter accessibility barriers on Jaws Physical Therapy:

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