Name
Age
Phone
Email
example@example.com
Orofacial Dysfunction
Abnormal Swallow
Dysfunctional Oral Habits
Tongue, Lip, & Other Oral Ties
Tongue Thrust
Low Oral Muscle Tone
Low Tongue Posture
Orthodontic Relapse
Thumb/Finger Sucking
Mouth Breathing
Clenching/Grinding
TMJD
Sleep Apnea/UARS
Snoring
Other
Doctor
Phone
Email
example@example.com
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