• NEW PATIENT FORM

    Welcome to our practice. Please fill out this form to help us better serve you.
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  • Medical History

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  • COVID SCREENING

  • Oral Hygiene Habits




  • Dental Information

  • Sleep Medicine

    You are almost there! We know it is a long form but this information is very important for us.
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  • Understanding your score:

    0-25 is indicative of mild obstruction;

    25-50 is indicative of moderate obstruction;

    50-100 is indicative of severe obstruction;

    If you have any degree of nasal obstruction we recommend that you see your GP and an ENT for assessment. 

  • Snoring is a sign of airway obstruction that can range from annoying and disturbing for your partner to life threatening sleep apnea. 

    Dont ignore the snore! 

    We can help you with that.

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  • Understanding your score:

    0-10 is considered normal;

    11-14 is considered mild excessive sleepiness;

    15-17 is considered moderate excessive sleepines;

    18-24 is considered severe excessive sleepines;

    If you scored above 11 we recommend that you see a sleep medicine specialist 

    to diagnose and treat the cause of your sleepiness.

     

  • Good quality sleep is fundamental for a healthy and enjoyable life, we really recommend that you seek help if you are not happy with the quality of your sleep.

    We can recommend and refer you on to a sleep specialist.

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  • I confirm that the information provided above is true and correct to the best of my knowledge.

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