sleep apnea

Please make certain to fill out all five forms before you come for your first visit so that we can spend your entire first visit diagnosing your dental condition and mutually establish the trusting, caring relationship we value having with all our patients.

  1. Medical History Form
  2. Patient Account Information
  3. Corah's Dental Anxiety Scale
  4. Mount Sinai Dental Fear Inventory
  5. Sleep Apnea
  6. No Show & Cancellation Policy

Name *
Name
Home Phone *
Home Phone
Work Phone
Work Phone
Do you experience any of these problems? *
Do you ever wake from sleep with a choking sound or gasping for breath? *
Has your bed partner noticed that you snore or stop breathing while you sleep? *
Do you have any of these other symptoms? *
Do you have any of these physical features? *