Self-Assessment Quiz
Check any present or past symptoms. Please be advised this is simply a self-assessment tool and is not a medical diagnosis.
Symptoms
Mouth Breathing
Snoring
Clenching/Grinding
TMD (Jaw Pain)
Daytime Sleepiness
Insomnia
Restless Sleep
Sleep Walking
Bed Wetting beyond 6 yrs.
Frequent Sore Throat
Strong Gag Reflex
Difficulty Swallowing Certian Foods
Picky Eating
Open Mouth Chewing
Difficulty Swallowing Pills
Chapped Lips
Crowding/Malocclusion
Frequent Congestion
Asthma
ADD/ADHD
Acid Reflux
Anxiety/Chronic Stress
Family history of OSA
Chronic Head/Neck/Shoulder Pain
Chronic Ear Infections
Chronic Migraines/Headaches
Speech Issues
Tongue Rests Low/Protrudes
Thumb-sucking
Nail Biting
Prolonged Pacifier
Receded Chin
Sleep Apnea
Chronic Throat Infections
History of Ear Tubes
Name
First Name
Last Name
Email
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