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Teens Online Assessment

Please complete the Teen assessment questionnaire below.

Mouth Breathing

Open mouth teen photo
Does your teen breathe through their mouth when they are awake or asleep?

Jaw Pain

TMJ Disorders - Model of Jaw showing TMJ joint location
Has your teen ever mentioned jaw pain or clicking?

Snoring

Snoring photo teen

Does your teen snore?

Frequent Headaches

Headache teen photo
Does your teen experience frequent headaches?

Daytime Fatigue or Brain Fog

Lack of focus teen photo
Does your teen struggle with daytime fatigue or brain fog?

Speech Disorders such as a Lisp or Unclear Speech

Speech disorders teen photo
Does your teen struggle with speech disorders such as a lisp or unclear speech?

Teeth Grinding at Night

Teeth grinding teen photo
Does your teen grind their teeth while sleeping?

Anxiety or Chronic Stress

Chronic stress teen photo
Does your teen experience anxiety or chronic stress?

Social Withdrawal or Difficulty Making Friends

Isolation withdrawal photo
Has your teen been withdrawing from society or having difficulty making friends?

Slouching or Forward Head Positioning

Head posture teen photo
Does your teen slouch or have a forward head posture?

Difficulty Focusing or Staying Organized

Disorganized teen photo
Does your teen have difficulty focusing or staying organized?

Academic Struggles in Reading or Comprehension

Reading issues teen photo
Does your child struggle in school with reading or comprehension?

Overbite, Underbite, or Dental Crowding

Teenage girl with braces
Has your teen's dentist told you that they may have an overbite, underbite, or dental crowding?

Irritability or Emotional Outbursts

Irritability teen photo
Is your teen often irritable or subject to emotional outbursts?

Difficulty with Athletic Coordination or Sports Endurance

Athletic ability teen photo
Does your child struggle with athletic coordination or sports endurance?

Low Self Confidence or Self-Esteem

Low self confidence photo
Has your teen expressed feelings of low self confidence or self-esteem?
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.

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

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469-865-8057

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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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Tuesday
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Wednesday
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Friday
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Saturday
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Sunday
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DESIGN AND CONTENT ©
2013-
2025
BY
DENTALFONE

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