Home / Symptom Assessment Form

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

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

Generally, if any of these questions can be answered “yes” you are 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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