Name
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First Name
Last Name
Phone Number
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Email
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Review the list below to see if Myofunctional Therapy is a good fit for you.
Snoring
Insomnia, Restless Sleep, Daytime Sleepiness OR Sleepwalking
Family History of Obstructive Sleep Apnea (OSA)
Sleep Apnea
Bed Wetting (beyond 6 years)
TMJ (jaw pain)
Chronic Head/Neck/Shoulder/Pain
Chronic Throat Infections, Ear Infections OR Headaches
Clenching/Grinding
Strong Gag Reflex
Difficulty Swallowing Certain Foods, Pills OR Picky Eating
Speech Issues
Open Mouth Chewing
Acid Reflux
Mouth Breathing
Chapped Lips
Frequent Congestion
Asthma
ADD/ADHD
Anxiety/Chronic Stress
History of Ear Tubes
Tongue Rests Low/Posture
Thumb Sucking, Nail Biting OR Prolonged Pacifier
Receded Chin
Do you have one or more of the above symptoms? If so, Myofunctional Therapy may be a benefit for you. Let's chat!
PLEASE NOTE THIS IS A SELF-ASSESSMENT, NOT A MEDICAL DIAGNOSIS
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