Birch and Bloom Myofunctional Therapy
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Reason for care
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Appointment info
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Prescreener
Reason for care
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Contact information
What symptoms are you experiencing? Check all that apply.
Acid reflux/ GERD
ADHD/ behavioral issues
Anxiety
Chronic/ frequent infections (ears, throat, respiratory)
Clenching/ grinding
Dental problems (cavities, gingivitis, periodontitis)
Depression
Digestive issues
Fatigue
Headaches/ migraines
Neck/ shoulder/ back tension/pain
PCOS/ infertility
Sleep problems (snoring, restless, insomnia)
Sleep apnea
Speech concerns
Teeth crowding
TMJ disorder
Trouble eating/ picky eater
Other- please specify below
What would you like to discuss? What are your main concerns?
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If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.
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