Forms

Please download and complete the following forms prior to your visit. Once completed, please fax it to (949) 502-8855 or bring it completed to your first visit.

TMJ/OROFACIAL PAIN PATIENTS

Health History Form Click to download

TMJ Orofacial Pain Consent Form Click to download

Notice of Privacy Practices Form
Please review this form. You do not have to bring it in. You will be asked to sign on the TMJ Orofacial Pain Consent form (the form above) that you acknowledge having been given the opportunity to review it. Click to download

 

SLEEP PATIENTS

Please download and complete the following forms prior to your visit. Once completed, please fax it to (949) 756-1008 or bring it to your first visit.

Health History Form Click to download

Snoring/Obstructive Sleep Apnea Consent Form Click to download

Notice of Privacy Practices Form
Please review this form. You do not have to bring it in. You will be asked to sign on the Snoring/Obstructive Sleep Apnea Consent form (the form above) that you acknowledge having been given the opportunity to review it. Click to download

 

REFERRING PHYSICIANS AND DENTISTS

Click to download a referral form

All forms require Adobe Reader to print.  Most computers already have this program installed, but if yours does not Adobe Reader is a free download available at http://get.adobe.com/reader/.