While the completed referral form is all that is required to begin, providing the full list of patient documents below allows our clinical team to conduct a more comprehensive initial evaluation. We appreciate your partnership in optimizing patient outcomes.
Referral Form (Click Image to Download)
Most Recent Clinical Progress Notes
Relevant Medical History & Medications
CPAP/BiPAP History of Intolerance, Explanation of Why.
LOMN & RX for Oral Appliance Therapy
Sleep Study Report with Interpretation and Diagnosis
How to submit:
Please send the completed referral form and any supporting documentation to our team via fax or email:
Fax:
734-361-3948
