WELCOME TO GOOD NIGHT DENTISTRY
SLEEP TREATMENT EXPERTS
Ronald M Cox, DDS, Diplomate of the American Board of Dental Sleep Medicine
REFERRING PHYSICIAN
Written prescription order for a custom, titratable oral appliance – See Below
A copy of the most recent sleep test (PSG/ HST)
Information needed for Obstructive Sleep Apnea Cases:
Medical Insurance information (optional and if available)
Written prescription order for a custom, titratable oral appliance (see Forms)
Copy of the Baseline Sleep Study & most recent PSG/ HST
Copy of the Medical chart notes prior to PSG/ HST & most recent notes discussing sleep issues
Letter of Medical Necessity
CPAP Intolerance Form (see Forms)
Copy of CAPAP stop Order Form (sent to DME company to stop supplies)