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Are you tired of grinding your teeth?

Thank you for taking time to provide input on the bruxism technology we are developing. We appreciate your insight as a patient and hope to maintain continual contact as we develop a device that meets your needs. Please provide your contact information below so we can keep you up-to-date on developments.

Patient Survey

* Indicates required field

How often do you grind your teeth? *

Frequently (>20 days per month) Sometimes (10-19 days per month) Infrequently (5-10 days per month) Rarely (<5 days per month) Never

What do you dislike most about teeth grinding? *

Noise Headache Jaw pain Teeth damage Annoying to partner/others

If Others please specify: *

Which device features are most important? *

Low cost Rechargable Track bruxing events Easy to fit to your mouth Bluetooth Sold at Walmart, CVS, etc. Sold at the clinic Suggested by dentist Clinical data supports effectiveness of device Battery life

For an over-the-counter device that has a battery life of one month, what is the most you would be willing to pay? *

Less than $50 $50 - $74 $75 - $99 $100 - $149 $150 - $199 Greater than $200

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Patient Contact Form

* Indicates required field

Name *

First

Last

Email *

Location *

Phone Number *

Comment *

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UA-102264206-1

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