1.In what country do you currently reside?

United States

Other (please specify)

2.What state do you reside in?

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*3.What type of provider are you looking for?(Required.)

Airway focused DentistAirway focused ENTOrofacial Myofunctional TherapistCranial Sacral TherapistAirway focused OsteopathAirway focused ChiropractorAirway focused Speech Language pathologistAirway focused Functional NutritionistAirway focused BodyworkerOther (please specify)