Allan K Bernstein, DDS
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New Patient Forms
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2034 E Southern Ave Suite H, Tempe, AZ 85282  l   Phone: 480-820-6800
Two convenient ways to contact us: Phone: 480-820-6800   l 
OSB: Oral Systemic Balance
Welcome

New Patient Forms For SA & TMD

Sleep Apnea Forms
All forms will need Adobe Acrobat Reader to open -
if the forms will not open please download the reader here:
http://www.adobe.com/products/reader/


Sleep Apnea - Authorization To Release Records

Sleep Apnea - Chart Initial Sleep Appointment

Sleep Apnea - Consent Disclosure Form

Sleep Apnea - Epworth Sleepiness Scale

Sleep Apnea - Medical Health History

Sleep Apnea - Pain Evaluation

Sleep Apnea - Patient Information Sheet

Sleep Apnea - Questionnaire

 

Temporomandibular Joint Forms
All forms will need Adobe Acrobat Reader to open -
if the forms will not open please download the reader here:
http://www.adobe.com/products/reader/


Temporomandibular Joint - Authorization To Release Records

Temporomandibular Joint - Chart Initial Sleep Appointment

Temporomandibular Joint - Consent Disclosure Form

Temporomandibular Joint - Medical Health History

Temporomandibular Joint - Medical Health History Continued

Temporomandibular Joint - Pain Evaluation

Temporomandibular Joint - Patient Information Sheet



Welcome

 
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