GROW: Progress Form
Share your progress and any soreness or appliance concerns, then submit your updates.
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have any sore teeth?
Yes
No
Is your appliance broken?
Yes
No
Does your bite feel uneven?
Yes
No
Does your appliance feel loose?
Yes
No
Is your jaw joint sore or making noise?
Yes
No
Does your face or head feel sore?
Yes
No
Does your neck hurt?
Yes
No
Does anywhere in your body feel sore?
Yes
No
Where?
Are you snoring?
Yes
No
Has it been difficult to do your PLAY exercises lately?
Yes
No
Have you been wearing your appliances as directed?
Yes
No
I have noticed improvements in my…
Athletic ability
Sleeping
Growth
Breathing
Ability to stay calm and focused
Posture
Uncontrollable movements
Speech
Comments
Submit
Should be Empty: