About Us

Dr. Judy Sturm & Associates is a place of comfort, care, and friendliness.  We look forward to welcoming you to our Dental Family.

Monday-Thursday: 8am to 6pm, Friday 8am-3pm 77 Bloor St W #1202, Toronto, ON M5S 1M2, Canada 416-967-4212 admin@yorkvillesmiles.com
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Patient Form – Healthy Start

Smile
1 Patient Form
2 Speech Questionnaire for Children
3 Specific Articulation - Final
  • Sleep Disordered Breathing Questionnaire for Children

    Earl O. Bergersen, DDS, MSD

    Please indicate to what degree your child exhibits any of the following symptoms using the scale of severity below. The initial score column should be evaluated and dated at first appointment and the follow-up score column should be evaluated and dated after 3 months of treatment by the same person who filled out the initial assessment.

  • Not Present: 0

    Very Mild: 1

    Mild: 2

    Moderate: 3

    Pronounced: 4

    Severe: 5

  • 1. Snoring of any kind
  • 2. Snores only infrequently (1 night/ week) (1 night/ week)
  • 3. Snores fairly often (2-4 nights/week)
  • 4. Snores habitually (5-7 nights/week)
  • 5. Has labored, difficult, loud breathing at night
  • 6. Has interrupted snoring where breathing stops for 4 or more seconds
  • 7. Has stoppage of breathing more than 2 times in an hour
  • 8. Hyperactive
  • 9. Mouth breathes during day
  • 10. Mouth breathes while sleeping
  • 11. Frequent headaches in morning
  • 12. Allergy symptoms*:
  • 13. Excessive sweating while asleep
  • 14. Talks in sleep
  • 15. Poor ability in school*
  • 16. Falls asleep watching TV
  • 17. Wakes up at night
  • 18. Attention deficit
  • 19. Restless sleep
  • 20. Grinds teeth
  • 21. Frequent throat infections
  • 22. Frequent ear infections
  • 23. Feels sleepy and/or irritable during the day
  • 24. Difficult time listening and often interrupts
  • 25. Fidgets with hands or does not sit quietly*:
  • 26. Ever wets the bed
  • 27. Bluish color at night or during the day
  • 28. Nightmares and/or night terrors
  • 29. Exhibits any of the following*:
  • 30. Speech problems**
  • **If scored greater than 0, please continue to Speech Questionnaire on the page 2.

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Call us at 416-967-4212 to see how we can help your smile reach its full potential.
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