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Child Online Assessment

Please complete the Child Assessment Questionnaire below.

Mouth Breathing or Open Mouth Posture at Rest

Sleep with mouth open
Does your child experience mouth breathing or an open mouth posture at rest?

Snoring or Noisy Breathing at Night

Sleep disorders photo
Does your child snore or breath noisily when sleeping?

Messy Eating / Food Falls Out

Child messy eater photo
Is your child a messy eater or has trouble keeping food in their mouth?

Speech Difficult to Understand

Speech communication photo
Do you find your child's speech difficult to understand at times?

Prolonged Thumb or Pacifier Sucking

Baby with pacifier photo
Has your child continued to suck a thumb or pacifier?

Picky Eating / Gags Easily

Picky eater photo
Is your child a picky eater, or do they have a sensitive gag reflex?

Speech Disorders such as a Lisp or Unclear Speech

Therapy practice photo
Has your child been diagnosed with a speech disorders such as a lisp or unclear speech?

Tongue Rests Low in the Mouth

Low tongue photo
Have you noticed it that your child's tongue rests low in the mouth?

Eats Very Slowly or Tires Quickly when Eating

Asleep at table photo
Does your child eats very slowly or tire quickly when eating?

Frequent Eye Fatigue or Vision Tracking Issues

Eye tracking photo
Does your child experience frequent eye fatigue or vision tracking issues?

Difficulty with Reading or Math in School

Trouble at school photo child

Does your child have difficulty with reading or math in school?

Difficulty Sustaining Attention or Focus

Child focus photo
Does your child have difficulty sustaining attention or focus?

Behavior Challenges or Frequent Meltdowns

Child meltdown photo
Behavior Challenges or Frequent Meltdowns
Opt-In to Electronic Communication

Please note that e-mail is not a secure form of communication. Medical information placed here may not be confidential. Please use this form to send your contact information, and we will respond to your inquiry using a secure method. This form should not be used by children under the age of 18.
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MarvelMyo & Speech

CALL OUR OFFICE

469-865-8057

FAX OUR OFFICE

817-668-0288

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MarvelMyo & Speech

Call Our Office

469-865-8057

Fax Our Office

817-668-0288
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HOURS
Monday
Closed
Tuesday
7:30am - 6:30pm
Wednesday
7:30am - 6:30pm
Thursday
7:30am - 6:30pm
Friday
7:30am - 6:30pm
Saturday
Closed
Sunday
Closed
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2013-
2025
BY
DENTALFONE

We are ready to help you or your child on your journey to optimal health!

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