www.summitdentaloflamesa.com

Referral Form
For Patients with Head, Neck and Facial Pain & Sleep-Related Breathing Disorders/Apnea*

Migraines or primary headachesSleep Apnea/snoringRestless sleepingCPAP IntoleranceDrowsiness during daytimeAttention deficit childrenStuffiness/ringing in ears or earachesBack/neck/shoulder pain or stiffnessDizzinessSoreness or pain in TM jointsClicking sounds or grating in TM jointsLimited ability to open mouthLocking jaw (opened or closed)Undiagnosed teeth pain or facial painProblems swallowingNone
In the event that a patient experiences one or more of these symptoms, it is critical that they be examined by a dentist trained in TM and Sleep disorders. We are committed to assisting you in the diagnosis and treatment for possible Temporomandibular, Craniomandibular, Sleep Apnea, or Sleep-Related Breathing Disorder.
Patient Information
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Referral Form