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Functional Oral Health
Breathe well, Live well
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Breathing
Myofunctional Therapy
Myo Munchee
Biological Dentistry
Sleep
Nutrition
Professional Referrals
By learning to breathe well and improve oral muscle tone with myofunctional therapy, we develop faces that function the way nature intended.
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Professional Referral Form
Referring Practitioner Name
Practitioner Email
Practitioner Phone Number
Patients Name
Parent/Guardian Name
Date of Birth
Phone
Email
Reason for Referral (please check all that apply)
Infant Oral Wellness Check
Tongue & Lip Ties
Orthodontic Support
Mouth Breathing
Sleep Related Breathing Concerns
Myofunctional Therapy
Oral Habits (thumb/finger sucking)
Myomunchee
TMD (Head,Neck,Facial Pain)
Teeth Grinding
Additional Notes
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