If you are looking for a checklist for your dental and other professionals, this one is fully EDITABLE in PowerPoint format.

We have found that none of our referral sources want another piece of paper to fill out so we have created these, laminated them, and given them out to HANG at each station or in each room.

The doctor or RDH can use the dry erase marker (we included) to check the concerns and the parent can take a picture of the entire form that has our contact information on it. Then the referring office can erase it and put it back up on the wall!

When the parent calls us, they can tell us what was checked on the screening form or send it to us because there is NO identifying information on it!

You can remove all of our logos, add your own, edit the screening items, and put your contact information on it. Presto instant referral and screening form! Plus you can change it later if needed!


EDITABLE Myofunctional Screening/Referral Checklist -- For Referral Sources


    (336) 350-9263

    3102 S. Church St. Ste 102 Burlington NC  27215

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