{"id":566,"date":"2025-07-15T21:13:40","date_gmt":"2025-07-15T21:13:40","guid":{"rendered":"https:\/\/bridgerchildrensdentistry.com\/?page_id=566"},"modified":"2025-07-16T15:29:09","modified_gmt":"2025-07-16T15:29:09","slug":"psq-new","status":"publish","type":"page","link":"https:\/\/bridgerchildrensdentistry.com\/?page_id=566","title":{"rendered":"Pediatric Sleep Questionnaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"566\" class=\"elementor elementor-566\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5b8b86 e-flex e-con-boxed e-con e-parent\" data-id=\"a5b8b86\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e7723ff elementor-widget elementor-widget-spacer\" data-id=\"e7723ff\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f44fb1f elementor-widget elementor-widget-heading\" data-id=\"f44fb1f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Pediatric Sleep Questionnaire<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-66ff780 e-flex e-con-boxed e-con e-parent\" data-id=\"66ff780\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fa9a120 elementor-widget elementor-widget-wpforms\" data-id=\"fa9a120\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-elementor-widget-fa9a120\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-fa9a120 {\n\t\t\t\t--wpforms-field-text-color: #376071;\n--wpforms-label-color: #376071;\n--wpforms-button-background-color: #8DC63F;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-552\"><form id=\"wpforms-form-552\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"552\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F566\" data-token=\"f5824e53f664732ec4c5083e39dd33bd\" data-token-time=\"1778501914\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-552-field_1-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-552-field_1\">Today&#039;s Date <\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-552-field_1\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][1][date]\" aria-errormessage=\"wpforms-552-field_1-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-552-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">Patients First &amp; Last Name  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-552-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" aria-errormessage=\"wpforms-552-field_2-error\" required><label for=\"wpforms-552-field_2\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-552-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" aria-errormessage=\"wpforms-552-field_2-last-error\" required><label for=\"wpforms-552-field_2-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-552-field_3-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"3\"><div id=\"wpforms-552-field_3\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-552-field_3-error\"><h5>On October 31, 2017, the American Dental Association created a mandate on sleep-related breathing disorder as follows:<\/h5>\n<p class=\"p1\">\u201cThe policy emphasizes the dentists' role in screening sleep-related breathing disorders as significant since dentists are often the first to identify symptoms and discuss medical and dental history with the patient.<span class=\"Apple-converted-space\">\u00a0 <\/span>The policy recognizes the importance of referral of at-risk patients to a physician for diagnosis and treatment\u2026In children, screening through history and clinical examination may identify signs and symptoms of deficient growth and development or other risk factors that may lead to airway issues. If risk is determined, intervention through medical or dental referral or treatment may be appropriate to help treat the disorder and\/or develop an optimal physiologic airway and breathing pattern\u201d.<\/p>\n<h5 class=\"p1\">It is our responsibility and privilege as your child\u2019s primary dental provider to screen for these problems. We at Bridger Children\u2019s Dentistry are committed to your child\u2019s oral-facial and airway health.<\/h5>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-552-field_4-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"4\"><div id=\"wpforms-552-field_4\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-552-field_4-error\"><h4>While sleeping does your child\u2026<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-552-field_7-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Snore more than half the time?<\/legend><ul id=\"wpforms-552-field_7\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_7_1\" name=\"wpforms[fields][7]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_7_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_7_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_7_2\" name=\"wpforms[fields][7]\" value=\"No\" aria-errormessage=\"wpforms-552-field_7_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_7_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_7_3\" name=\"wpforms[fields][7]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_7_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_7_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_8-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">Always Snore?<\/legend><ul id=\"wpforms-552-field_8\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_8_1\" name=\"wpforms[fields][8]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_8_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_8_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_8_2\" name=\"wpforms[fields][8]\" value=\"No\" aria-errormessage=\"wpforms-552-field_8_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_8_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_8_3\" name=\"wpforms[fields][8]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_8_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_8_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_9-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Snore Loudly?<\/legend><ul id=\"wpforms-552-field_9\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_9_1\" name=\"wpforms[fields][9]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_9_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_9_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_9_2\" name=\"wpforms[fields][9]\" value=\"No\" aria-errormessage=\"wpforms-552-field_9_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_9_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_9_3\" name=\"wpforms[fields][9]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_9_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_9_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_10-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Have \u201cheavy\u201d or loud breathing?<\/legend><ul id=\"wpforms-552-field_10\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_10_1\" name=\"wpforms[fields][10]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_10_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_10_2\" name=\"wpforms[fields][10]\" value=\"No\" aria-errormessage=\"wpforms-552-field_10_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_10_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_10_3\" name=\"wpforms[fields][10]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_10_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_10_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_11-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Have Trouble breathing or struggle to breathe?<\/legend><ul id=\"wpforms-552-field_11\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_11_1\" name=\"wpforms[fields][11]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_11_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_11_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_11_2\" name=\"wpforms[fields][11]\" value=\"No\" aria-errormessage=\"wpforms-552-field_11_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_11_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_11_3\" name=\"wpforms[fields][11]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_11_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_11_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_12-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"12\"><div id=\"wpforms-552-field_12\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-552-field_12-error\"><h4>Have you ever\u2026<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-552-field_13-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">Seen your child stop breathing during the night?<\/legend><ul id=\"wpforms-552-field_13\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_13_1\" name=\"wpforms[fields][13]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_13_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_13_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_13_2\" name=\"wpforms[fields][13]\" value=\"No\" aria-errormessage=\"wpforms-552-field_13_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_13_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_13_3\" name=\"wpforms[fields][13]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_13_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_13_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_14-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"14\"><div id=\"wpforms-552-field_14\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-552-field_14-error\"><h4>Does your child\u2026<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-552-field_15-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Tend to breathe through the mouth during the day?<\/legend><ul id=\"wpforms-552-field_15\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_15_1\" name=\"wpforms[fields][15]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_15_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_15_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_15_2\" name=\"wpforms[fields][15]\" value=\"No\" aria-errormessage=\"wpforms-552-field_15_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_15_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_15_3\" name=\"wpforms[fields][15]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_15_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_15_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_16-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">Have a dry mouth on waking up in the morning?<\/legend><ul id=\"wpforms-552-field_16\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_16_1\" name=\"wpforms[fields][16]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_16_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_16_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_16_2\" name=\"wpforms[fields][16]\" value=\"No\" aria-errormessage=\"wpforms-552-field_16_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_16_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_16_3\" name=\"wpforms[fields][16]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_16_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_16_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_17-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Occasionally wet the bed?<\/legend><ul id=\"wpforms-552-field_17\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_17_1\" name=\"wpforms[fields][17]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_17_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_17_2\" name=\"wpforms[fields][17]\" value=\"No\" aria-errormessage=\"wpforms-552-field_17_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_17_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_17_3\" name=\"wpforms[fields][17]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_17_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_17_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Wake up feeling un-refreshed in the morning?<\/legend><ul id=\"wpforms-552-field_18\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_18_1\" name=\"wpforms[fields][18]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_18_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_18_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_18_2\" name=\"wpforms[fields][18]\" value=\"No\" aria-errormessage=\"wpforms-552-field_18_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_18_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_18_3\" name=\"wpforms[fields][18]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_18_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_18_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Have a problem with sleepiness during the day?<\/legend><ul id=\"wpforms-552-field_19\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_19_1\" name=\"wpforms[fields][19]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_19_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_19_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_19_2\" name=\"wpforms[fields][19]\" value=\"No\" aria-errormessage=\"wpforms-552-field_19_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_19_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_19_3\" name=\"wpforms[fields][19]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_19_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_19_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-552-field_5-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"5\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-552-field_5\" >or the as<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-552-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-552-field_20-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Has a teacher or other supervisor commented that your child appears sleepy during the day?<\/legend><ul id=\"wpforms-552-field_20\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_20_1\" name=\"wpforms[fields][20]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_20_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_20_2\" name=\"wpforms[fields][20]\" value=\"No\" aria-errormessage=\"wpforms-552-field_20_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_20_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_20_3\" name=\"wpforms[fields][20]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_20_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_20_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_21-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Is it hard to wake your child up in the morning?<\/legend><ul id=\"wpforms-552-field_21\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_21_1\" name=\"wpforms[fields][21]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_21_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_21_2\" name=\"wpforms[fields][21]\" value=\"No\" aria-errormessage=\"wpforms-552-field_21_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_21_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_21_3\" name=\"wpforms[fields][21]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_21_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_21_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_22-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Does your child wake up with headaches in the morning?<\/legend><ul id=\"wpforms-552-field_22\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_22_1\" name=\"wpforms[fields][22]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_22_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_22_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_22_2\" name=\"wpforms[fields][22]\" value=\"No\" aria-errormessage=\"wpforms-552-field_22_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_22_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_22_3\" name=\"wpforms[fields][22]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_22_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_22_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_23-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Did your child stop growing at a normal rate at any time since birth?<\/legend><ul id=\"wpforms-552-field_23\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_23_1\" name=\"wpforms[fields][23]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_23_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_23_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_23_2\" name=\"wpforms[fields][23]\" value=\"No\" aria-errormessage=\"wpforms-552-field_23_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_23_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_23_3\" name=\"wpforms[fields][23]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_23_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_23_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">Is your child overweight?<\/legend><ul id=\"wpforms-552-field_24\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_24_1\" name=\"wpforms[fields][24]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_24_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_24_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_24_2\" name=\"wpforms[fields][24]\" value=\"No\" aria-errormessage=\"wpforms-552-field_24_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_24_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_24_3\" name=\"wpforms[fields][24]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_24_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_24_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_25-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"25\"><div id=\"wpforms-552-field_25\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-552-field_25-error\"><h4>This child often\u2026<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-552-field_26-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"26\"><fieldset><legend class=\"wpforms-field-label\">Does not seem to listen when spoken to directly<\/legend><ul id=\"wpforms-552-field_26\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_26_1\" name=\"wpforms[fields][26]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_26_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_26_2\" name=\"wpforms[fields][26]\" value=\"No\" aria-errormessage=\"wpforms-552-field_26_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_26_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_26_3\" name=\"wpforms[fields][26]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_26_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_26_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_27-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Has difficulty organizing tasks<\/legend><ul id=\"wpforms-552-field_27\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_27_1\" name=\"wpforms[fields][27]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_27_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_27_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_27_2\" name=\"wpforms[fields][27]\" value=\"No\" aria-errormessage=\"wpforms-552-field_27_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_27_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_27_3\" name=\"wpforms[fields][27]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_27_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_27_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Is easily distracted by extraneous stimuli<\/legend><ul id=\"wpforms-552-field_28\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_28_1\" name=\"wpforms[fields][28]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_28_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_28_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_28_2\" name=\"wpforms[fields][28]\" value=\"No\" aria-errormessage=\"wpforms-552-field_28_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_28_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_28_3\" name=\"wpforms[fields][28]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_28_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_28_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_29-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"29\"><fieldset><legend class=\"wpforms-field-label\">Fidgets with hands or feet or squirms in seat<\/legend><ul id=\"wpforms-552-field_29\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_29_1\" name=\"wpforms[fields][29]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_29_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_29_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_29_2\" name=\"wpforms[fields][29]\" value=\"No\" aria-errormessage=\"wpforms-552-field_29_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_29_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_29_3\" name=\"wpforms[fields][29]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_29_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_29_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_30-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"30\"><fieldset><legend class=\"wpforms-field-label\">Is \u201con the go\u201d or often acts as if \u201cdriven by a motor\u201d<\/legend><ul id=\"wpforms-552-field_30\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_30_1\" name=\"wpforms[fields][30]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_30_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_30_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_30_2\" name=\"wpforms[fields][30]\" value=\"No\" aria-errormessage=\"wpforms-552-field_30_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_30_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_30_3\" name=\"wpforms[fields][30]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_30_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_30_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-552-field_31-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"31\"><fieldset><legend class=\"wpforms-field-label\">Interrupts or intrudes on others (e.g. butts into conversations or games)<\/legend><ul id=\"wpforms-552-field_31\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_31_1\" name=\"wpforms[fields][31]\" value=\"Yes\" aria-errormessage=\"wpforms-552-field_31_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_31_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_31_2\" name=\"wpforms[fields][31]\" value=\"No\" aria-errormessage=\"wpforms-552-field_31_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_31_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-552-field_31_3\" name=\"wpforms[fields][31]\" value=\"Don&#039;t Know\" aria-errormessage=\"wpforms-552-field_31_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-552-field_31_3\">Don't Know<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-552-field_5-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-552-field_5-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-552-field_5-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"552\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=\/wp\/v2\/pages\/566\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-552\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/bridgerchildrensdentistry.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Pediatric Sleep Questionnaire Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Today&#039;s Date Patients First &amp; Last Name * FirstLast On October 31, 2017, the American Dental Association created a mandate on sleep-related breathing disorder as follows: \u201cThe policy emphasizes the dentists&#8217; role in screening [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-566","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=\/wp\/v2\/pages\/566","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=566"}],"version-history":[{"count":0,"href":"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=\/wp\/v2\/pages\/566\/revisions"}],"wp:attachment":[{"href":"https:\/\/bridgerchildrensdentistry.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=566"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}