Chart 2.

Questionnaire to assess the prevalence of self-medication among patients with temporomandibular disorder.

1.What is your main complaint, the reason for your appointment? 2.How long after your symptoms began did you seek professional help? 3.Who was the first person who contacted for help? ( ) Dentist ( ) Physiotherapist ( ) Speech Therapist ( ) Doctor – general clinic ( ) Doctor – Otolaryngologist ( ) Doctor – Neurologist ( ) Doctor – Other specialty: _________ ( ) Other: ______________________________

4.Have you taken any medication based on your own decision (without a prescription) before seeking this help? ( ) YES, which medicine? ( ) NO

5.When you took the medication you self-prescribed, did you ask anybody for help and if so, who? ( ) Pharmacist ( ) Clerk ( ) Friend/ Neighbor ( ) Relative ( ) Other __________________________________

6.Are you currently taking any medication? ( ) YES For what? Was it prescribed by a professional? ( ) YES ( ) NO