Med Hx - Patient Intake Survey

Please allow approximately 20 minutes for the survey.

Referral for Orofacial Myofunctional Therapy (97112) and a therapeutic exercise program (97110) should be provided by Primal Air therapists. These services are not available within my practice. (The referring provider signature is required to proceed with therapy.)

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Primal Air is a premier practice specializing in orofacial myofunctional therapy, breathing, chewing, sleep, and overall health, led by the esteemed author, speaker and trainer, Shirley Gutkowski. With a focus on optimizing oral and facial muscle function, Primal Air offers cutting-edge treatments designed to enhance breathing, swallowing, and overall dental health.

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1266 W Main St, Sun Prairie, WI 53590, USA

Copyright 2025

Primal Air OMT . All rights reserved

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Primal Air is a premier a practice specializing in orofacial myofunctional therapy, breathing, chewing, sleep, and overall health, led by the esteemed author, speaker and trainer, Shirley Gutkowski. With a focus on optimizing oral and facial muscle function, Primal Air offers cutting-edge treatments designed to enhance breathing, swallowing, and overall dental health.

we are on the map

1266 W Main St, Sun Prairie, WI 53590, USA

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  • 1266 W Main St, Sun Prairie, WI 53590

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Copyright 2025

Primal Air OMT . All rights reserved