Patient Referral Form

Patient Referral Form

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Dear Dental Provider and Team,

Thank you for entrusting me with the care of your patients. It is always a pleasure to collaborate with you, and I appreciate your confidence in my ability to provide TMD treatment for your patients. I am committed to ensuring that your patients have a positive experience and receive the highest quality care. I value our partnership and look forward to continuing to work together.

Please  print the downloadable referral form and fax to 520-299-1739 or you may scan and email to merchant@arizonasleepandbreathing.com or submit the form online.

Download referral form                                                             Online referral submission