Booking Form: Initial Myofunctional Therapy Assessment


Your journey begins with a comprehensive myofunctional therapy assessment carried out by our therapist team. This one-hour consultation allows us to fully understand your current muscle function, breathing patterns, and airway-related symptoms.


During this appointment, we will:

  • Record full baseline clinical findings

  • Complete a detailed myofunctional assessment of tongue posture, lip seal, swallow pattern, and breathing function

  • Review relevant dental, airway, and sleep history

  • Discuss whether myofunctional therapy is appropriate for your individual presentation


A written follow-up summary letter outlining our findings and recommendations will be provided after the assessment.

First Name

Last Name

Email

Phone Number

Date of Birth

Is this appointment for a Child?

This appointment can be booked for both adults and children. If booking for a child, this form must be completed by a parent or legal guardian on their behalf.

Billing Details


Billing Address

Address Line 1

Address Line 2

Town/City

Postcode

County

Total
£200
...

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