INFORMATION FOR DOCTORS AND OTHER HEALTH CARE PROFESSIONALS
Now with 2 locations
La Salle serving Winnipeg and Eastern Manitoba: 204-736-4399
Portage La Prairie serving the Portage area and Western Manitoba: 204-814-0111

Do You Suffer from TMJ?

1. Do you have morning headaches? Yes No
2. Do you have stiff jaws or locked jaws in the morning? Yes No
3. Do you have frequent earaches? Yes No
4. Do you have more than 2 headaches per week? Yes No
5. Do you have jaw pain when you eat? Yes No
6. Do you take more than 4 painkillers per week for HA? Yes No
7. Does your jaw make noise when you open? Yes No
8. Have you noticed a change in your bite? Yes No
9. Does your jaw lock on occasion? Yes No
10. Is your jaw locked now (can’t open wide)? Yes No

Interrested in a More Comprehensive TMJ Test?

If your test results indicate that you may be suffering with some form of TMJ, please talke the time to complete a more detailed test to help our TMJ specialists identify the type of treatment best suited for your individual needs.
You may take our more detailed test by clicking here.

Please note that there is a $9.95 fee to take the test – this will be reimbursed if you schedule for an assessment and diagnosis.

© 2025 - The TMJ & Sleep Therapy Centre
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New Patient Forms

Use our Online Patient Questionnaire:  LAUNCH IT HERE!

Patient Questionnaires:

DOWNLOAD - our TMJ and Sleep Apnea Questionnaire

DOWNLOAD - our Functional Orthodontics and Orthopedics Questionnaires

Referral Forms:

DOWNLOAD - our Adult TMD, Snoring & Sleep Apnea form

DOWNLOAD - our Pediatric TMD & Airway form

  • Scan and e-mail it to: ac.gn1570397810irons1570397810jmt@o1570397810fni1570397810
  • Portage La Prairie & Western Manitoba
    • Fax forms to: 204-814-0133
    • Or drop it off at: unit 105 140-9th Street, Portage La Prairie, Mb, R1N 3V5
  • Winnipeg & South Eastern Manitoba
    • Fax forms to: 204-736-8210
    • Or drop it off at: 4-49 Rue Principale, La Salle, MB R0G 0A2

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