Please fill out the inquiry form below to be added to the Myofunctional Therapy Waitlist. Client Name * First Name Last Name Parent(s) Name(s) - if applicable First Name Last Name Client Date of Birth * MM DD YYYY Phone * (###) ### #### Email * What symptoms are you or your child currently experiencing? * Please select any current or past interventions * Palatal Expansion Orthodontics Tongue and/or Lip Frenectomies Speech Therapy Other What goals are you looking to reach through myofunctional therapy? * Any additional information you would like to share regarding your inquiry: * Thank you for your inquiry!You have been added to the waitlist.You will be contacted by The Village YXE admin when an appointment comes available.