Patient Referral Form

Dear Physical Therapy and Chiropractic Providers,

At Arizona Sleep and Breathing, we work in close collaboration with DPT as well as Chiropractor who provides therapy in conjunction with balancing bites with neuromuscular treatment methods in our office! Physical therapy is an effective treatment for TMD.

It is always a pleasure to welcome your patients, and I am particularly grateful for your trust in my abilities to provide them with TMD care. 

I will do my best to ensure that they have a positive experience and that their needs are met. I appreciate your confidence in my practice, and I look forward to working with you and your patients in the future.

Please fill the downloadable referral form and fax to 520-299-1739, You may also scan and email to merchant@arizonasleepandbreathing.com, or submit the form online.

Download referral form                           Online referral submission