816-795-1000 or 1-866-No-Snore (1-866-667-6673)
 
 

Dr. Larry Pribyl's		  
Center for TMJ and Sleep Apnea
The premiere treament center for headache and snoring conditions. Sleep is interwoven with every facet of our health and well-being, our moods and behavior, energy and emotions, marriages, jobs, our very sanity and happiness.
 
  Referrals    
 
 
   
  This page is for our referring physicians to use when sending a patient to our office. This page is equipped with all needed referral information. It will expedite the referral process. Thank you for being a part of what we do.
   
 
Patient First Name: * Required
Patient Last Name: * Required
Email Address: * Required
Phone Number: * Required
Mobile Number: Recommended to receive text!
Referring Physician: * Required
Referring Physician Phone: * Required
   
Referral for:  
  TMJ
  Snoring
  Apnea
  Orthodontics
   
  3D CBCT (cone bean CT)
  3D CBCT with Radiology report
  3D CBCT to plan implant placement
 
  Tooth #s for implants
  Implant system used
  Prepare surgical guide
 
  Tooth #s for implants
  Implant system used
   
Additional information you would like us to know (optional)
   
Please confirm these characters:
   
 
This form will take a moment to process, please be patient.
   
You will receive a disc of all images taken.
All CT scans are reviewed by an Oral Maxillofacial Radiologist.
 
 
 
   
 
 
 
 
     
 
1-866-NoSnore (1-866-667-6673)
  
     
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