Thank you for choosing TMJ and Sleep Therapy Centre
to aid you in your path to whole-body wellness. 

Please complete the forms below before your appointment.

  1. Patient’s Health Questionnaire Form

  2. XRAY Consent Form

  3. HIPAA-Consent Form

 The Patient Health Questionnaire may be completed on your computer allowing easy return through email and no use of paper.

Please be sure to bring a copy of your insurance card and your photo ID with you. Submitting these forms in advance will assist Dr. Shirazi in evaluating your specific needs prior to your appointment as well as ensure that your scheduled appointment is processed in a timely manner. This also allows us to remain on schedule for all patients.

TMJ & Sleep Therapy Centre
of Conejo Valley and Los Angeles

555 Marin St. Suite #108,
Thousand Oaks, CA 91360
805.496.5700

11980 San Vicente Blvd. #619
Brentwood, CA 90049
310.401.0813

Office Hours:

Monday - Thursday: 8:30am-5:30pm

Closed Friday - Sunday

TMJ & Sleep Therapy Centre ©2019. All rights reserved.

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