Is Myofunctional Therapy Right for You?
Let’s find out! This short self-assessment will help you discover if you or your child could benefit from myofunctional therapy. Myofunctional therapy can improve breathing, sleep, focus, posture, and even facial growth — things most people never realize are connected! This takes about 2–3 minutes. When you finish, you’ll have the option to schedule a consultation call directly through my calendar.
Your Full Name
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First Name
Last Name
Your Email Address
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example@example.com
Your Phone Number
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Who is this assessment for?
Myself
My Child
How old is your child
Child's Breathing & Airway
Does your child breathe through their mouth during the day?
Does your child snore, especially at night?
Do they have frequent congestion, allergies, or nasal obstruction?
Child's Sleep
Does your child have restless sleep or wake frequently?
Do they sleep with their mouth open?
Child's Oral Habits
Does your child suck their thumb, fingers, or a pacifier beyond age 3?
Do they chew on objects, nails, or have other oral habits?
Do they have difficulty keeping lips closed at rest?
Child's Tongue & Swallow Habits
Does your child push their tongue forward when swallowing?
Does your child have trouble chewing certain foods or need to swallow multiple times?
Have you noticed a tongue tie or restricted tongue movement?
Child's Speech & Sounds
Does your child have speech that is hard to understand?
Do they have trouble pronouncing sounds like “s,” “t,” “d,” “n,” “l,” “r”?
Child's Facial & Posture Signs
Does your child have a narrow or high palate?
Do they frequently tilt their head forward or lean while breathing?
Child's Developmental & Behavioral
Do you notice frequent fatigue during the day?
Any history of orthodontic treatment or referral for airway concerns?
Child's Breathing & Airway
Does your child breathe through their mouth during the day?
Does your child snore, especially at night?
Do they have frequent congestion, allergies, or nasal obstruction?
Child's Sleep
Does your child have restless sleep or wake frequently?
Do they sleep with their mouth open?
Child's Oral Habits
Does your child suck their thumb, fingers, or a pacifier beyond age 3?
Do they chew on objects, nails, or have other oral habits?
Do they have difficulty keeping lips closed at rest?
Child's Speech & Sounds
Does your child have speech that is hard to understand?
Do they have trouble pronouncing sounds like “s,” “t,” “d,” “n,” “l,” “r”?
Child's Tongue & Swallow
Does your child push their tongue forward when swallowing?
Does your child have trouble chewing certain foods or need to swallow multiple times?
Have you noticed a tongue tie or restricted tongue movement?
Child's Facial & Posture Signs
Does your child have a narrow or high palate?
Do they frequently tilt their head forward or lean while breathing?
For Kids Only
My child is a picky eater or avoids certain textures
My child drools or sleeps with their mouth open
My child has frequent congestion or ear infections
My child has dark circles under their eyes
My child struggles to focus or sit still
My child grinds teeth or snores at night
My child has had orthodontic work or was told they may need it
Breathing & Airway
Do you primarily breathe through your mouth during the day?
Do you wake up with a dry mouth or throat?
Have you been diagnosed with sleep apnea or other breathing issues?
Do you snore at night?
Sleep
Do you often feel tired or groggy during the day?
Do you wake frequently at night?
Oral & Tongue Habits
Do you notice tongue thrusting when swallowing or at rest? where your tongue pushes on your front teeth when swallowing?
Do you chew on objects, nails, or have other oral habits?
Do you have difficulty keeping lips sealed at rest?
Swallow & Eating
Do you need to swallow multiple times for liquids or solids?
Do you experience jaw tension, clicking, or discomfort while eating?
Do any of these sound familiar?
I breathe mostly through my mouth
I wake up with a dry mouth or sore throat
I snore or grind my teeth
I have nasal congestion or allergies
I sleep with my mouth open
I've been told I stop breathing or gasp in my sleep
Speech & Vocal Patterns
Do you notice difficulty articulating certain sounds (s, t, d, n, l, r)?
Do you experience tension in your tongue or throat while speaking?
Facial / Postural Awareness
Do you have a high, narrow palate or feel your tongue rests low in your mouth?
Do you notice neck, shoulder, or jaw tension during the day?
Do you often tilt your head forward or lean while breathing or talking?
How would you rate your sleep?
I sleep GREAT 6-8 hours, never wake up
4-6 hours a night
I sleep terrible 2-4 hours a night
Never wake up
wake up 1 time a night
Wake up still tired
General Awareness / Health
Do you experience frequent headaches, migraines, or TMJ discomfort?
Have you had orthodontic treatment, palate expansion, or tongue-tie release?
Picky eating
Are there textures of foods you dislike certain foods because of how they feel
Do you have a hyperactive gag reflex
do you chock on water when you are drinking
do you tend to bit on your cheeks or tongue while eating
Tongue, Lips & Swallowing
I have trouble keeping my lips closed when resting
I've been told I have a tongue-tie or lip-tie
I have difficulty swallowing pills or liquids
I use my lips, cheeks, or head movement to help me swallow
I drool at night or during the day
I've noticed speech sounds that are hard to make (like /s/, /l/, or /r/)
My tongue rests on the bottom of my mouth instead of the roof
Jaw Posture & Tension
I experience jaw clicking, popping, or soreness
I clench or grind my teeth
My neck and shoulders feel tight
I rest my chin in my hands often
My head sits forward instead of upright
I’ve been told I have TMJ or facial tension
Do you feel tension in your face and/or neck?
Does your lower jaw or chin seem to pull back (retrognathic profile)
Developmental & Behavioral
Do you notice frequent fatigue during the day?
Any history of orthodontic treatment or referral for airway concerns?
Have you had orthodontic treatment, or are you considering it?
Have you had any release in the past (tongue, lip, buccal)
Have you been diagnosed with sleep apnea or any other airway issues?
Briefly describe any concerns or issues you are experiencing related to your oral or facial health.
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