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    Screening Form

    For patients with head, neck and facial pain & sleep-disordered breathing/apnea

    When your patients experience one or more of these symptoms, they should have a thorough evaluation by a dentist trained in TMD and Sleep. We will be happy to assist you in diagnosis and treatment for possible crandiomandibular/temporomandibular dysfunction or sleep-disordered breathing/apnea.

    Patient Information:

    Referred By: