Does your child have a tongue-tie?

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33%

Baby Issues (Past or Preset)*

Painful nursing or shallow latch

Reflux or spitting up often

Milk dribbling out of the mouth when eating

Difficulty bottle-feeding

Excessive gassiness or fussiness

Clicking or smacking noise when eating

Slow or poor weight gain

Prolonged feeding time at the breast or on the bottle

Child to Adult Issues

Frustration with communication

Crooked, crowded teeth, or highly-arched palate

Frequent headaches or neck pain

Trouble with speech sounds, hard to understand, or mumbling

Thumb or finger sucking or prolonged pacifier use

Mouth breathing during the day

Slow eater or trouble finishing a meal

Grinds teeth at night

Recurrent ear infections

Picky eater, especially with textures (e.g. meat, mashed potatoes)

Sleeps with mouth open

Frequent sinus issues/upper respiratory infections

Choking or gagging on liquids or foods

Jaw joint (TMJ) issues (popping, clicking, or pain)

Hyperactivity or inattention

Snores (quiet or loud)

Spitting out food or packing food in cheeks

Patient’s Name*

Email*

Age*

Phone*

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Request an appointment by calling our office or fill out the contact form. A staff member will contact you to schedule your appointment. If you submit this form outside of our office hours, we will contact you during our next business day.

954‑722‑1100

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8333 W. McNab Rd., Suite 104
Tamarac/Fort Lauderdale, FL 33321

Welcome nearby cities: Coral Springs, Coconut Creek, Fort Lauderdale, Lauderdale Lakes, Lauderhill, Margate, North Andrews Gardens, North Lauderdale, Oakland Park, Parkland, Plantation, Pompano Beach, Sandalfoot Cove, Sunrise, Wilton Manors

MON, TUE, THU
7:00am – 4:00pm

WED, FRI
7:00am – 12:30pm

(954) 722-1100

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