Request an Appointment

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You're in good hands.

We'll follow up within one business day. If you're ready to move quickly, you can also book directly at SquareOneOMT.com.

Client Information

Client First name

Client Last name

Parent/ Guardian First Name ( If Applicable)

Parent/ Guardian Last Name ( If Applicable)

Phone number

Email address

Preferred Method of Contact

Call

Text

What Brings You In?

Mouth Breathing

Tongue Tie Evaluation

Low Tongue Posture

Finger / Thumb Sucking

Facial Pain/ Head & Neck Tension/ TMJ Pain

Snoring / Sleep Apnea

Jaw Surgery Pre/Post Op Care

Unwanted Tooth Movement

Tongue Thrust

Teeth Grinding

Other

How did you hear about us?

Questions/ Concerns / Preferred Appointment Time

If there's anything else that you would like me to know prior to your appointment, please include it here.

Your information will be encrypted.

You're in good hands.

We'll follow up within one business day. If you're ready to move quickly, you can also book directly at SquareOneOMT.com.

Lauren Brittan

Myofunctional Therapist

Telephone 617-297-8555

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