Referring Your Patient for a TMJ Consult

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Referring Your Patient for a TMJ Consult

You are concerned for your patient and finding a solution to their problems is paramount.
Dr. Scott Rose accepts both Medical and Dental referrals for those patients whom you feel suffer from TMJ disorders and concurrent signs and symptoms.

Once we receive your referral our team will contact your patient and arrange a consult with a team member or with Dr. Scott Rose as is appropriate.

Simply:
1. Fill out the attached Referral Form below
or
2. Print the form here and fax ((440) 542-1202) to our office


Referral Form:

 

Doctors information:

Introducing:  
Referred by:  
Date:  

Please call (440) 542-1202 to schedule your consultation visit.

date:
time:
  (for example: January 30, 2010)
am pm

Welcome to our office! we look forward to meeting you. During your consultation appointment, the extent of your Temporomandibular Disorder (TMD) will be discussed.
Dr. Scott Rose will just determine the type of testing required and when it would be best to begin. The time required for treatment, and an outline of fees for our professional services
will be given. We will be glad to help you with any financial arrangements.
Your appointment time is reserved especially for you. Parents or guardians must
accompany children and adolescent to this visit.
     
Patient information:
Patient:  
Referred by:  
Phone:  
Date:   (for example: January 30, 2010)
     
Purpose of the referral:
  Headaches
  Neck / Back pain
 
TMJ pain
  Pain or Ringing in ears
  Grating sound in TMJ
  Clicking, Snapping or Popping in jaw joints
  Numbness
  Teeth grinding or clenching
  Sensitive teeth
  Difficulty chewing
  Partial inability to open
 
 

 

TMJ Referring Doctors Guide

Search for studies on related TMJ Disorder symptoms and Bite relationship problems:

Abfraction   Hearing Loss
 
Alzheimer   HIP
     
A/O Joint   HPA
     
Autonomic   Meniere
     
Autism   Mercury / Amalgam
     
Autoimmune   Multiple Sclerosis
     
Bleaching / Bonding   Occlusion
     
Bruxing / Clenching   OSA
     
Burning Mouth / Taste   Parkinson's
     
Cardiovascular   Posture
     
Centric Relation   Scoliosis
     
Dizziness / Vertigo / Nausea   TENS
     
Dysphagia   Tinnitus
     
EMG   TMD / CMD
     
Estrogen / Hormones   Tonsil / Adenoid
     
Eustachian Tube   Tori
     
Fatigue   Tourette
     
Fibromyalgia   Trigeminal
     
GERD    
     
Headache / Migraine   Miscellaneous

 

Download Dr. Scott Rose's Ebook 'TMJ - Real Life Stories'.

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