Patient Referral Form

We do not offer sleep studies. We treat sleep, breathing, and orofacial disorders after testing, or when no testing is required.

Physician Information

Referring Practice *

Phone *

Fax *

Referring Doctor *

Patient Information

Name *

Date of Birth *

Phone *

Email Address *

Patient Diagnosis/Symptoms

(Please check all that apply)

Open mouth rest posture of the lipsForward rest posture of the tongueWeak lip musclesMalocclusionTMD/TMJBreathing issues including enlarged tonsils & adenoids, or allergiesDifficulty chewing, gathering, or swallowing solids & liquidsSpeech DisordersTongue-tie / lip-tieSnoring, difficulty sleeping, or tiredness

Please do not fill in this field.

Sleep Morganton

509 E Parker Rd Morganton, NC 28655

Monday-Thursday: 8AM-4PM | Friday: 8AM-3PM

(828) 276-8202