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.

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Self-Assessment

This form is protected by copyright laws and may not be altered or used for personal or commercial gains.

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.

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Provider Screening Forms

Screening for Sleep Disorders

This download includes:

STOP-Bang Questionnaire
Epworth Sleepiness Scale
Pediatric Sleep Questionnaire
Hypersomnia Disorders Assessment

Fill out the form above to access your free download!

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:

Mallampati Score
Friedman Tongue Position
Friedman Tonsil Grading
Chairside Airway Screening Form
Intervention Protocols for airway health

Fill out the form above to access your free download!

Airway Patency Assessment - Download.png

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.