NEW PATIENTS

Prior to your visit with us, we ask that you complete the New Patient form (available below).  Additional Forms (available below) can be printed and turned in at your first appointment.    Additionally, we ask that you bring in your medical insurance card, photo ID and a list of any current medications you are taking.  

REQUIRED FORMS FOR FIRST VISIT INCLUDE: 

Privacy Practices - Financial Policy - New Patient Questionnaire - Non-Dental Patient Release

YES, I've had a Sleep Study...

If your most recent sleep study is less than 2 years old, you have a viable study for treatment.  

At your first visit, Dr. Bennardo will complete a thorough intra and extra oral examination.  We will also take diagnostic images to determine if you are a candidate for oral appliance therapy.  

If you have not obtained a prescription for therapy prior to your initial visit, we will try to obtain one for you from your primary care physician or specialist.  Therapy can not begin until a signed prescription is on file with our office.  

NO, I haven't had a Sleep Study...

If you have never completed a sleep study or your most recent sleep study is more than 2 years old, you will need to complete a baseline sleep study.  The results of the sleep study will help us determine if treatment is needed and what treatment options are suitable.  

At your first visit, Dr. Bennardo will complete a thorough intra and extra oral examination to check for any dental indications that may be associated with sleep apnea.  We will also take diagnostic images. 

After the exam, we will contact your primary care physician or specialist to obtain a signed order for a home sleep test.  Once obtained, we will forward the order, sleep screener and your insurance information to the sleep testing company for benefit verification.  The sleep testing company will call you to take the next steps.  

NEW PATIENT FORM

Patient Information

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Primary Medical Insurance

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Secondary Medical Insurance

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Medical Contacts

I certify that this information is true and accurate to the best of my knowledge. 

Thanks for submitting!

ADDITIONAL FORMS