Patient Referral Forms

For your convenience and ease of patient referral, we have provided referral forms for download here in Adobe Acrobat PDF format. The Adobe Acrobat Reader is FREE and can be downloaded at

Referral forms are for:  Oral Appliance Therapy from Physician, NP, Dentists, CPAP Providers, Physio/Occupational and Chiropractic therapists and for Level III Home Sleep Study with Medical Interpretation for undiagnosed but symptomatic patients. If you have a patient to refer and am unclear please feel free to use the main referral for appliance therapy form or call/email us with your questions. PATIENTS can self refer without a referral form by contacting us or scheduling online.

Please print and complete these forms for any patient you wish to refer and fax to (604) 987-5336 or email to for NORTH VANCOUVER office or (604) 587-5336 or email for SURREY office