Infant Online Assessment

Please complete the infant-assessment questionnaire below.

Latch Issue

Latching photo
Does your child have difficulty with latching during breastfeeding?

Leaking Milk

Leaking milk photo
Does your infant leak milk during feeding?

Falling Asleep

Sleep nursing photo
Does your infant have trouble staying awake during feeding?

Arching Back

Arching photo
Does your infant arch backwards during feeding?

Open Mouth Posture while Sleeping

Open mouth photo
Does your infant sleep with an open mouth?

Lip Blisters after Feeding

Blister mouth photo
Does your infant experience lip blisters after feeding?

Frequent Gas or Fussiness

Gassy baby photo
Is your infant frequently gassy or fussy after feeding?

Preference for One Side

Prefer one side photo
Does your infant show a preference for one side over the other when feeding?

Clicking Noises while Feeding

Clicking noise photo
Do your infant make clicking noises when feeding?

Frequent Reflux or Spit-Up

Spit up photo
Do your infant experience reflux or frequently spit up after feeding?
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. This form should not be used by children under the age of 18. If you prefer to speak to us directly, you are also welcome to call us so that we may assist you.

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MarvelMyo & Speech

CALL OUR OFFICE

469-865-8057

FAX OUR OFFICE

817-668-0288

EMAIL OUR OFFICE

EMAIL US
location
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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2025
BY
DENTALFONE

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