Request a Free Consultation – Las Vegas, NV

We are here to help! Start by filling out this form, and we will contact you to schedule your FREE consultation. If you have any other questions ahead of this visit, please give us a call!

Full Name

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Are You..... Select A New Patient An Existing Patient

How did you hear about us? Search Engine Family/Friend Doctors Office Promotion Social Media Other

My specific concern is...(select all that apply) I am looking for treatment to stop my snoring I am looking for an alternative treatment to my CPAP I am looking for treatment to stop my jaw pain and headaches (TMJ/TMD) I am looking for myofunctional therapy I am looking for a treatment to improve my child's sleep and breathing Other (please explain below)

Have you taken a sleep study in the past 2 years? Yes No, I had a sleep study over 2 years ago No, I have never had a sleep study

Have you ever been diagnosed with Sleep Apnea? Yes No

Are you currently using a CPAP machine? Yes No, I never had a CPAP machine No, I could not tolerate the CPAP machine

Are you currently using an oral appliance? Yes No

Do you have any questions or comments?