Oral Myology Program Consent

Permission for Exchange of Information

I give permission to exchange medical information, either written or by phone, between my providers of medical and therapeutic services (or those of my child), as well as insurance providers. I understand that the purpose of this exchange is to allow for coordinated services between these providers.

Permission to Use Files for Research or Presentations

I give my permission for use of photographs and records made in the process of examination and treatment, to be used for the purposes of research, education, and publication in professional journals.

Success of Therapeutic Program

It must be noted that successful completion of the oral myology program is dependent upon patient desire, good attitude, and self-discipline. Parental involvement and encouragement are important and necessary. Only the dedicated participants and cooperation of the patient can guarantee effective swallowing and resting posture results.

Airway Problems and Their Effects

In order to be successful in this program, the patient must achieve closed mouth resting posture. A clear airway is necessary in order to reach this goal. Patients who have allergies or related nasal airway problems present a high risk that the goals will not be attained or may require additional visits to do so.

Tongue/Lip Ties and Their Effects

In some cases, if the tongue and/or lip ties are deemed to be tight or restrictive, it may have an impact on treatment success. While it is ultimately the patient and/or guardian’s choice whether or not to undergo the recommended release procedures if deemed beneficial, awareness of potentially limiting outcomes is required, such as not being able to maintain the tongue position up in the palate due to a very restrictive tongue tie holding it down, among other potential limitations.


In some cases, postural issues and compensations may be noted, which may result in the recommendation for adjunctive “body work” (ie chiropractics, physiotherapy, or massage). There is a fascial layer running from the tongue down to the toes, meaning the body is connected. An issue in one area can lead to compensations or issues in other areas. While we are focusing on the oral part of the equation, addressing the other areas of the body may enhance the oral myology treatment and may make the case more successful overall. By not pursuing recommended body work, the patient and/or guardian understands that while not necessary to see some results, this is a potential limitation in overall outcome.