WELCOME TO GOOD NIGHT DENTISTRY

SLEEP TREATMENT EXPERTS

REFERRING PHYSICIAN

Information needed for Primary Snoring Cases:

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)

 

Forms available for download

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