Referral Form


TMJ & Sleep Therapy Centre of North Texas

TMJ & Sleep Therapy Centre of North Texas

Shab Krish, DDS, MS

Diplomate
American Board of Craniofacial Pain
American Board of Craniofacial Dental
Sleep Medicine

1005 Long Prairie Road #300
Flower Mound, TX 75022
Phone: 972-538-3777
Fax: 972-538-3751
www.krish.com

Please fax referral to TMJ & Sleep Therapy Centre and give a copy to the patient

When your patients experience one or more of these symptoms, they should have a thorough evaluation by a dentist trained in TM and Sleep. We will be happy to assist you in diagnosis and treatment for possible Craniomandibular, Temporomandibular or Sleep Disordered Breathing/Apnea.

Patient Information

Patient Name:
Address
Phone
Email
Date
Fax
Referring Doctor & Phone Number
SCREENING FORM

For Patients with Head, Neck and Facial Pain & Sleep Disordered Breathing/Apnea