new patient forms

Please print out each of these forms, fill them out and fax them to our office at 502.451.5857. If you do not have access to a fax machine, please be sure to bring them with you on your first visit.

Medical History
Family and Social History
Sleep Screening Questionnaire
Epworth Sleepiness Scale
Berlin Questionnaire Sleep Evaluation
Sleep Center Evaluation
Informed Consent
Financial Policy

Physician/Dentist Referral Form
Please download this form, print it and give it to your physician or dentist to fill out prior to referring you for treatment. Thank you.

Oral Appliance Referral Form

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These forms are available as Adobe Acrobat pdf files. On a slow connection, theymay take a minute or so to load - please be patient. If you do not have the latest version of the Adobe Acrobat Reader it is available as a free download here