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Free Screenings
For patients & providers
Below are free screening forms to help identify potential airway restrictions and tethered oral tissues. Printable PDF formats are available for download.
Self-Assessment
If you answer yes to any of the listed symptoms, you could have an airway resistance disorder or tethered oral tissues. Further evaluation by a trained myofunctional therapist is recommended for individualized care.
This form is protected by copyright laws and may not be altered or used for personal or commercial gains.
Provider Screening Forms
Screening for Sleep Disorders
This download includes the STOP-Bang Questionnaire, Epworth Sleepiness Scale, Pediatric Sleep Questionnaire, and an assessment for Hypersomnia Disorders.
This form is protected by copyright laws and may not be altered or used for personal or commercial gains.
Airway Patency Assessment
This download includes information on the Modified Mallampati Score, the Friedman Tongue Position, the Friedman Tonsil Grading, a chairside Airway Screening Form, and basic Intervention Protocols for airway health.
This form is protected by copyright laws and may not be altered or used for personal or commercial gains.
Disclaimer: Nothing recommended within this website is to be taken as direct medical or dental advice. This platform is used as a way to share information and have open, constructive conversations. Always consult your healthcare provider(s) before implementing any dietary or lifestyle supplementation or modifications.