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 adobe.com.
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 firstname.lastname@example.org. for NORTH VANCOUVER office or (604) 587-5336 or email email@example.com for SURREY office
- Referral for Diagnostic Level III Sleep Study with Interpretation
pdf, 120.08 KB
- Referral from Physician / NP for Oral Appliance Therapy
pdf, 121.73 KB
- Referral from CPAP provider for Oral Appliance Therapy
pdf, 121.66 KB
- Referral from PT/ OT/ DC and other therapists
pdf, 246.21 KB
- Referral form for TMJ/ TMD assessment and consultation
pdf, 220.04 KB
- Dental Office referral form
pdf, 218.88 KB