Myo Self Assesment

Myo Self Assessment
Name*

First NameLast Name
Email*
example@example.com

Infancy/ Early Childhood History. Please check all that apply.

Difficulty nursing*BottlefedPicky eatingEar infections*Tubes in ears*Tonsillectomy, Adenoctomy, or both*Pacifier useSippy Cup useTongue or Lip Tie Release*

Calculation
Score Results (more than 10):Your answers above are highly indicative of an individual with an oromyofunctional disorder. We recommend you setup an appointment to be evaluated.
Score Results (less than 10):While your answers may not clearly present as an individual with an oromyofunctional disorder, some of your answers indicate that you may want to be evaluated.

Please hit complete to finish your screening and submit results. We will contact you as soon as possible.
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