Capturing Your Relevant Patient Information

Patient Forms
Please print and fill out these forms so we can expedite your first visit:

Forms for TMD or Sleep Apnea

• Dear Valued New Patient
• New Patient Health Questionnaire (6 pages)
• Medical Insurance Information
• Release of Medical Information
• Daytime Sleepiness Evaluation
• Affidavit for Intolerance or Non Compliance to CPAP
• Nighttime Sleepiness Evaluation
• Patient Consent Form
• Payment Policy

Forms for Dental

• Patient Registration (2 Pages)
• Medical History and Dental History (2 Pages)
• Patient Consent Form (1 Page)
• Daytime Sleepiness Evaluation (1 Page)