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Refer a Patient

Referral Form

Please complete the form below to electronically refer a new patient. Please note, when referring a patient to our offices, we need a copy of the patient’s Diagnostic Sleep Study with their prescription.

Submit Patient Referral


  • We follow AADSM protocol for treating obstructive sleep apnea.
  • We will always send progress letters so you can follow along with your patient’s treatment.
  • We always use the highest quality appliances. We are not one size fits all practice.
  • We are committed to continuing education for sleep apnea, oral appliance therapy and constantly challenging ourselves to read the latest studies and attend all sleep CE courses.
  • We are not afraid to inform a patient that Oral Appliance Therapy may not work for them based on our findings.
  • We educate patients on adjunct treatment options such as bed wedges, nasal cones/strips, sleep masks, diet/weight loss, and proper sleep hygiene.
  • We continue to see fantastic results with the use of oral appliances to treat obstructive sleep apnea.


Already referred a patient, but didn’t have their sleep study, submit it now.

Submit Sleep Study

Download Printable Referral PDF

If you prefer to fill out the paper version, you may download and fax the completed form to the S&G Family Dentistry office in Leawood @ fax: 913-600-5575.

Download Referral PDF
American Dental Association American Academy of Dental Sleep Medicine Kansas Dental Association