Forms
These forms are for all new patients. It will take you at least 15-20 minutes to complete in its entirety, and you are able to hit “save” and go back to the form if you have not finished it at one time. We appreciate you completing this form as soon as possible so we can start your file. We must receive this form at least 2 days before your first evaluation/session is scheduled, and sooner is preferred. We thank you for your thoroughness in answering these questions in order to enable us to provide you and your child with the best treatment possible!
CHILD New Patient Form (under 18 years old)
Speech/Language Therapy & OT Form – Child VersionMyofunctional Therapy Form
Child Version
ADULT New Patient Form (18 years and older)
Speech/Language Therapy & OT Form – Adult VersionMyofunctional Therapy Form
Adult Version
REFERRAL SLIP
For physicians, dentists, orthodontists, or other referral sources.
Download an editable PDF file of our Referral Form or click here to fill out the online version +
Nicole's passion for her work is palpable, and her dedication to her patients' success is truly remarkable. What struck me most was her personal connection to the field; hearing about her own journey overcoming sleep issues was not only inspiring but reassuring. I left our consultation feeling hopeful and empowered, knowing I had found a true partner in my health journey.
Based on Nicole's recommendation, I will be seeing a sleep specialist, confident that together with her guidance, we will find solutions to my challenges. It was an honor to meet Nicole, and I look forward to continuing to work with her until we resolve this issue. I cannot recommend Nicole and the Myofunctional Center highly enough for anyone seeking expert care with a deeply personal touch.
I reached out to Nicole in desperation. I was suffering from 9/10 chronic pain which led to the deterioration of my mental health.
I live in Australia and had little hope that I would get a reply, I had just been discharged from a psychiatric ward and the future wasn’t looking bright.
Not only did Nicole reply, she shared her knowledge and also reached out to a team of health professionals she knew in my area with the next steps in my journey. She was kind and most importantly, she was honest.
6 months have passed and I have my life back. I’m happy and hopeful again, back to enjoying my life. I wouldn’t be in this position
without Nicole and for that I am forever thankful.
If you are deciding whether or not to seek help, you are in the best possible hands here.
- Thank you Nicole.
I started seeing her for a tongue thrust. Through our behavior sessions, she discovered that I couldn’t breathe well through my nose leading to open mouth breathing. Multiple doctors confirmed this and I wound up having a septum repair. Also, she suspected that I had a small airway and upper airway resistance syndrome. Sleep drs and dentists confirmed this as well.
She’s been a continuous resource for me on doctors, breathing, sleep and issues of the mouth. She presents at conferences and has really strong relationships with the best doctors in her field who think really highly of her.
When my 5 month old daughter was born in Feb, she again was a resource for me about tongue and lip ties. She connected me with the best doctors and dentists in the field.
If you are thinking about going to another speech or myofunctional therapist, don’t! Nicole is the absolute best in San Diego and probably the US.
San Diego Center for Speech and Myofunctional Therapy for issues related to a tongue tie. Kris and Nicole were both amazing to work with and always took the time to answer any of my questions or concerns. Their knowledge is unmatched and I would highly recommend their services.
I highly recommend Nicole and her team!
I started seeing her for a tongue thrust. Through our behavior sessions, she discovered that I couldn't breathe well through my nose leading to open mouth breathing. Multiple doctors confirmed this and I wound up having a septum repair. Also, she suspected that I had a small airway and upper airway resistance syndrome. Sleep drs and dentists confirmed this as well.
She's been a continuous resource for me on doctors, breathing, sleep and issues of the mouth. She presents at conferences and has really strong relationships with the best doctors in her field who think really highly of her.
When my 5 month old daughter was born in Feb, she again was a resource for me about tongue and lip ties. She connected me with the best doctors and dentists in the field.
If you are thinking about going to another speech or myofunctional therapist, don't! Nicole is the absolute best in San Diego and probably the US.
