Refer a Patient You may refer patients to us by filling out the form below or by calling our office at 262-232-8777. Thank you! Provider Referral FormDoctor First Name Doctor Last Name Doctor's Email Doctor's Clinic Name Clinic Phone Number Clinic Fax Number Patient First Name Patient Last Name Patient Phone Number Patient Email What is the patient being seen for? TMJ Sleep ApneaPatient's Medical Insurance Tell us about your referral SEND Looking for TMJ pain relief? We'd love to help you! Schedule Appointment