NERVESYNC
DC-TMD Assessment Consent
FormDiagnostic Criteria for
Temporomandibular Disorders (TMD)
DC-TMD Assessment Consent
FormDiagnostic Criteria for
Temporomandibular Disorders (TMD)
Introduction to DC-TMD: The DC/TMD, established as the international standard since 2014, includes two critical components for assessing Temporomandibular Disorders:
Axis I: Physical diagnoses.
Axis II: Assessment of psychosocial status and pain-related disability.
This assessment protocol is validated for its high diagnostic accuracy in adults, using a standardized method that includes a detailed history and clinical examination.
Qualified Practitioner: Raelene Clark B.Sc., M.Sc.Med (Orofacial Pain), a specialist in Orofacial Pain, graduated from the University of Sydney Pain Management Program in 2021 and is qualified to conduct the DC-TMD Assessment.
Assessment Fee:
Cost per Page: $150
Total Estimated Cost: The report usually consists of 12-13 pages, totaling approximately $1950.00.
Payment Information: Please note that payment is required in full before the final report is released. Patients may have the option to claim this amount from their insurance company, or they may arrange for the insurance company to make direct payments to Nervesync | Perth Migraine Centre. Details on how to process this through your insurer will be provided upon submission.
Consent Agreement: By filling out the fields below, you agree to the terms and conditions of the DC-TMD assessment as outlined above.
Introduction to DC-TMD: The DC/TMD, established as the international standard since 2014, includes two critical components for assessing Temporomandibular Disorders:
Axis I: Physical diagnoses.
Axis II: Assessment of psychosocial status and pain-related disability.
This assessment protocol is validated for its high diagnostic accuracy in adults, using a standardized method that includes a detailed history and clinical examination.
Qualified Practitioner: Raelene Clark B.Sc., M.Sc.Med (Orofacial Pain), a specialist in Orofacial Pain, graduated from the University of Sydney Pain Management Program in 2021 and is qualified to conduct the DC-TMD Assessment.
Assessment Fee:
Cost per Page: $150
Total Estimated Cost: The report usually consists of 12-13 pages, totaling approximately $1950.00.
Payment Information: Please note that payment is required in full before the final report is released. Patients may have the option to claim this amount from their insurance company, or they may arrange for the insurance company to make direct payments to Nervesync | Perth Migraine Centre. Details on how to process this through your insurer will be provided upon submission.
Consent Agreement: By filling out the fields below, you agree to the terms and conditions of the DC-TMD assessment as outlined above.
NerveSync Pty Ltd
info@nervesync.com.au
19/3 Wexford Street
Subiaco, WA 6008
Opening Hours
Monday to Friday 8am - 5pm
NerveSync Pty Ltd
info@nervesync.com.au
19/3 Wexford Street
Subiaco, WA 6008
Opening Hours
Monday to Friday 8am - 5pm
NerveSync Pty Ltd
info@nervesync.com.au
19/3 Wexford Street
Subiaco, WA 6008
Opening Hours
Monday to Friday 8am - 5pm
