Airway
& Breathing
Questionnaire

Airway & Breathing
Questionnaire

Airway & Breathing Assessment

At St. Clair & Massey Orthodontics, your child’s overall health is our utmost priority. We understand that proper airway function is crucial for many health factors, including sleep quality, daytime focus, and overall well-being in children. This form will help us assess your child’s sleep and breathing conditions so we can tailor an effective treatment plan uniquely for them. Start your child’s journey towards improved airway health today by completing the form below.

*Note: All questions are required, so just do the best you can!

While sleeping, does your child...
Upon waking up, does your child...
Have you noticed that your child...
If you need to speak with us regarding a current patient, please do not use this form. Give us a call at 806-799-6780.