02 9601 5111
02 9601 5111

Orthognathic Surgery Questionnaire

Please complete this questionnaire prior to your consultation with the surgeon. Answer all questions to the best of your ability. The more accurate your responses the better the diagnosis and treatment offered.
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Please complete this questionnaire prior to your consultation with the surgeon. Answer all questions to the best of your ability. The more accurate your responses the better the diagnosis and treatment offered.

Name
1. What is the reason for your visit?
Please select all that apply
2. What would you like to improve about your facial appearance?
Please select all that apply
3. What is your impression of the type of treatment you need?
Please select all that apply
4. Have you had another surgical opinion?
5. Have you seen an orthodontist?
9. How keen are you to proceed with jaw surgery?