Myofunctional Therapy Consent

Myofunctional Therapy Informed Consent

Myofunctional therapy is a structured program of exercises designed to strengthen and retrain the muscles of the tongue, lips, cheeks, and face. The goal of therapy is to promote proper tongue posture, lip seal, nasal breathing, and healthy swallowing patterns.

Myofunctional therapy offers potential benefits including improved nasal breathing, better sleep quality, clearer speech, and easier chewing and swallowing. It may also support orthodontic treatment and help alleviate issues such as snoring, sleep-disordered breathing or sleep apnea, headaches, jaw pain, and abnormal oral or facial muscle function. Proper muscle function may contribute to improved facial growth, development, and overall oral health.

I understand that the success of myofunctional therapy depends largely on my (or my child’s) participation and consistency in completing assigned exercises at home, as instructed by the myofunctional therapist. Results may vary from patient to patient, and no guarantees have been made regarding specific outcomes.

I understand that myofunctional therapy is not considered “routine and customary” dental treatment. I understand it may be beneficial in my particular case, and I voluntarily consent to participate in myofunctional therapy.

Fee and Services

I understand that the fee for myofunctional therapy is $350, which includes:

• One (1) one-hour appointment with the myofunctional therapist (either in person or via zoom/FaceTime)
• Follow up appointments, as needed
• Myofunctional Therapy book of prescribed exercises

I understand that additional appointments or services, if recommended, may incur additional fees.

I have had the opportunity to ask questions regarding myofunctional therapy, its purpose, benefits, limitations, and alternatives. All of my questions have been answered to my satisfaction.

By signing below, I acknowledge that I have read and understand this informed consent, as well as fees associated, and agree to proceed with myofunctional therapy.