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Child-Tongue Restriction Questionnaire

Does your child have difficulty eating, challenges with speech development, or issues with sleeping, snoring, or mouth breathing? Did you struggle with nursing or bottle feeding? These could be signs of a tongue restriction, also known as tongue tie. To help us better understand your child’s needs, please take a moment to fill out our Tongue Restriction Questionnaire. Your responses will guide our evaluation process and help us create a personalized care plan to ensure your child’s oral and overall health. Click below to get started!

Birthday
Month
Day
Year
Date
Month
Day
Year

Please check any issues that apply to help us determine if a tongue restriction may be present.

How significantly do these issues impact quality of life?
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