FOR PHYSICIANS & DENTISTS

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PATIENT REFERRAL INFORMATION

We are referring our patient for a complementary analysis of a sleep breathing disorder. I understand that TMJ and Stop Snoring will advise me of his candidacy for treatment and keep me informed with all progress.

STATEMENT OF MEDICAL NECESSITY

I am requesting that Dr. Arora evaluate my patient and treat with an oral appliance, if medically necessary.

Thank you for your referral. If you have any questions please contact me at

(203) 469-5644 or email at TMJandstopsnoring@gmail.com