Home / Symptom Assessment Form For Parents

This questionnaire will provide a basis for my exam and allow me to focus on the specific symptoms that your child experiences.

Please answer the questions below to the best of your knowledge.

Generally, if any of these questions can be answered “yes”, your child is likely to have some myofunctional concerns. If you answer “yes” to multiple questions, myofunctional therapy will be recommended.

Thank you very much for taking the time!


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