Forms
Below is a compilation of informational forms, questionnaires, and instruction sheets used at Revive. For new patients, please feel free to print out the Patient Information form, HIPAA Compliance form, and the Revive Questionnaire and bring them with you to your consultation. Generally, a diagnosis can not be made by simply taking a questionnaire, so please set-up a consultation if you suspect you need treatment.
MYOFUNCTIONAL EXERCISES
Bi-weekly Orofacial Myofunctional Therapy Exercise sheet
CREDIT CARD AUTHORIZATION
Credit Card Authorization form
REVIVE QUESTIONNAIRE
Short patient screening questionnaire
SLEEP DISORDER
Sleep Disorder Questionnaire
COMPREHENSIVE SLEEP
Comprehensive Sleep Questionnaire
MYOFUNCTIONAL DISORDERS
List of common orofacial myofunctional disorders
MYOFUNCTIONAL FAQ'S
List of frequently asked questions regarding orofacial myofunctional therapy
FRENECTOMY POST-OP
Home care instructions after frenectomy
APPLIANCE CARE
Home care instructions on cleaning/caring for your appliance
BOTOX THERAPY
Home care instructions before and after Botox or Xeomin therapy
