Full Name *

Email *

City *

Date of birth *

Do you snore or breathe through your mouth at night?

Yes

Have you been diagnosed with sleep apnea?

Yes

Do you notice that you occasionally have your mouth open at rest or that you breathe through your mouth during the day?

Yes

Do you feel chronically tired or fatigued even when you get enough sleep?

Yes

Has anyone ever told you that you may be tongue-tied?

Yes

Do you regularly experience any issues with digestion? (stomach pain, gas, bloating, acid reflux, difficulty swallowing, etc.)

Yes

Have you had any nasal or airway surgeries or do you have a deviated septum?

Yes

Do you have any jaw pain, facial pain, or headaches on a regular basis?

Yes

Do you clench or grind your teeth or wear a night guard?

Yes

How would I feel if I got 8 hours of restorative sleep every night?

Thrilled

I already have amazing, restorative sleep

8 hours of restorative sleep? It's too good to be true!

Do you feel you get sick more else than everyone else?

Yes

Did you complete this quiz for yourself or someone else?

Self

Someone else

Who did you answer for?

Child age 2-4

Child 5 or over

Spouse

Generally, if any of these questions can be answered "yes", it is likely you have some myofunctional concerns. If you answered "yes", to multiple questions, myofunctional therapy would be a good option for you to explore.

To connect with us for a free, NO PRESSURE discovery consult call, please click here

https://myofunctionalpathways.janeapp.com/locations/oostburg-virtual/book?hl=en-US&gei=ePkpaZmhGuyGw8cPxa_eiAE&rwg_token=ACgRB3deAM-3eoOCPmVolpETAIjeTlKTIF2xDCyToAUU1HkFdh09OrwkyYZHsZJeHvsoKPX-fdrwOs-bHFeGWHu0te4dXZvZmw%3D%3D#/staff_member/2/treatment/4