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