Dear PatientWe are looking forward to your upcoming visit. If you have the opportunity, it is helpful to bring the following:1. A copy of your medical insurance card2. A copy of your "diagnostic sleep study" (can be faxed) 3. Completed Paperwork Phone Hours:Mon - Friday:9:00am to 7:00pmOffice Hours:Tues - Friday 9:00am to 7:30pmWhat to expect at your first visit:The visit will last approximately an hour and 15 minutesBenefits will be explained before incurring any fees30 minutes of the visit is spent doing paperworkPatients will be asked to take three X-raysThe doctors exam lasts around 30 minutesWe allow 15 minutes for impressionsPlease feel free to call with any questions. See you soon!Oak Brook: In Oakbrook Center (Mall) located at Kingery Highway (83) and 22nd. From 355 take 88 toward Chicago. Go to Midwest Rd take a right off ramp. Go to 22nd take a right. Go to Spring Rd take a left (Mc Donald’s). Go to Commericial take a Left. Take a right on mall loop (Cheesecake Factory) take a left on drive entering mall just past Bloomingdales (White Building). Park in parking garage on the right and walk up into mall. Tall professional building straight ahead. Oakbrook Center 120 Professional Building Suite 726 Oak Brook, IL. 60523. 161925133350
FORMCHECKBOX I have tried Positional Therapy and refuse to utilize the device.
FORMCHECKBOX I have not tried Positional Therapy, but refuse to use it and would prefer to try an Oral Appliance.
Please indicate which of the following statements apply:
FORMCHECKBOX The positional device does not stay in place and therefore does not prevent back sleeping<br /> FORMCHECKBOX The positional device disturbs my sleep <br /> FORMCHECKBOX The positional device does not help as I am still snoring, gasping, choking or sleepy<br />
FORMCHECKBOX I refuse to use a positional device because I sleep on my back and cannot tolerate side sleeping exclusively
FORMCHECKBOX I refuse to use a positional device; I experience pain while on my side & therefore must sleep on my back<br /> FORMCHECKBOX I refuse to use a positional device; I snore, gasp or choke on my side/back and therefore feel it is not enough<br /> FORMCHECKBOX Other: ______________________________________________________________________<br />Patient Signature: _______________________________________Date: _____________<br />