Struggling with snoring, poor sleep, or difficulty focusing? Airway issues may be the cause. Airway Dentistry helps improve breathing for better sleep, focus, and overall health. Answer the following questions to find out how we can help you!

I Am A? *

Adult Patient

Parent / Guardian For Child Patient

Teen Patient

How Old Is Your Child? *

0-2

3-6

7-10

11 or Older

Is Your Child Experiencing Any Of The Following Symptoms Associated With Airway Issues? *

Constant Mouth Breathing / Snoring

ADHD / Trouble Focusing

Behavior Concerns / Whining

Bed Wetting

Are You Experiencing Any Of The Following Symptoms Associated With Airway Issues? *

Chronic Fatigue / Sleeping Issues

Mouth Breathing / Snoring

TMJ / Jaw Pain

Chronic Headaches

Any Other Information You'd Like To Provide?

Our Practice Is Located In Melissa, TX. Are You Willing To Travel To This Location? *

Yes

No

First Name *

Last Name *

Postal Code *

Phone *

Email *

I Consent to Receive SMS Notifications and Alerts. We use SMS to provide a better patient experience to you and your family through convivence, comfort, and quick communication to our team.

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