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 – Los Angeles
2. Patient’s Health Questionnaire Form – Conejo Valley
3. Pediatric Intake and Screening Form – Los Angeles
4. Pediatric Intake and Screening Form – Conejo Valley
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.