281.296.6797
1.866.TMJ.TEXAS
1001 Medical Plaza Dr. Suite 200
The Woodlands, Texas 77380
 
"For years I have been experiencing a pounding sound and loss of hearing in my ears.  Not all the time but usually in the evenings.  All I could do is go to bedto escaoe it.  After using the splint mouth guard for only a couple of months I no longer experience the pounding or hearing loss.
-Sandy 
 






 

Patient Forms

  Welcome to the Center for Facial Pain & Dental Sleep Medicine
 
Thank you for considering our office for the diagnosis of your Headache, Facial Pain, Temporomandibular Joint Disorder or Sleep Disorders. Rest assured that you will have the latest in diagnostic procedures and the skill of a Board Certified doctor in Orofacial Pain and Dental Sleep Medicine. Our highly trained staff will answer any questions that you may have and assist you in an appropriate manner during the history and exam procedure.

Our ability to help you will depend on your thoroughness in filling out the assessment questionnaires you have been sent. We ask that you take some time out of your busy schedule to fill them out completely, honestly and accurately. This will benefit you directly as it greatly enhances the accuracy of our diagnosis for your medical condition. Most Facial Pain, TMJ and sleep disorders are complex in nature and require a significant amount of time to understand. There are many interacting factors that influence the symptoms that you are having at this time.
 
We work very hard to keep our fees as low as possible. One way we accomplish this is by having our patients pay at the time services are rendered. We provide our patients several convenient options: cash, debit cards, check, Visa, MasterCard, American Express, Discover cards and interest free long-term payment plans. We also provide an insurance claim form at the time of each appointment in order to file with your insurance company. 
 
As you fill in the following forms, please be sure to sign at the bottom of pages 2, 4 and 6. 
 
We look forward to meeting you for your scheduled consultation. If you have any questions or concerns, feel free to contact any member of our staff. They will be delighted to assist you.
 
 
 


   

 

Note:  Adobe Acrobat Reader is required to view and print the new patient forms. If you don’t have Adobe Acrobat Reader 8, click here to download.