Call Us: (304) 757-7428
Toll Free: (877) 757-7428
1401 Hospital Drive, Suite 102, Hurricane, WV 25526
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COMPLETE AND SUBMIT FORMS

TMJ Questionnaire

If you are seeing us for headache; TMJ-related pain or dysfunction; or head, neck or craniofacial pain; please complete the TMJ Questionnaire thoroughly as possible in advance of your visit. The information you provide is essential to making a differential diagnosis and developing a treatment plan that focuses on the cause(s) of your disorder – not just your symptoms.

Sleep Questionnaire

If you are seeing us for snoring, Obstructive Sleep Apnea or CPAP intolerance, please complete your Sleep Questionnaire as thoroughly as possible in advance of your visit. The information you provide is important to the screening and evaluation of your sleep problem and, once diagnosed, will be used to develop an individualized treatment plan.

In addition, if you have previously completed a sleep study (i.e., polysomnogram), please instruct your physician to fax a copy of it to our office in advance of your appointment. Our fax number is (304) 757-3535. If you prefer, you may also bring a copy of your sleep study with you to your appointment.

1401 Hospital Drive, Suite 102, Hurricane, WV 25526 USA
Jeanne K. Bailey, DDS Sleep, TMJ and Craniofacial Pain Treatment Center in West Virginia (304) 757-7428 (304) 757-3535 wvsleepandtmj@frontier.com