(720) 638-8093
Castle Rock
Make a Payment
Home
About Us
Our Team
Office Photos
Testimonials
Services
General & Family Dentistry
TMJ/Sleep Apnea
Dental Implants
Cosmetic Dentistry
Teeth Whitening
Tooth Colored Fillings
Invisalign®
BOTOX®
Crowns
Patient Info
Patient Forms
Smart Smiles Program
Financing
Blog
Contact Us
Schedule Appointment
Home
Our Team
Services
Testimonials
Patient Forms
Financing
Smart Smiles Program
Schedule Appointment
Contact Us
Make a Payment
Referring Doctors
Referring Doctors
Patient Name
*
First
Last
Patient Phone
*
Referring Doctor
*
Doctor Phone
*
Condition
*
TMD
Airway
Symptoms
*
Check all that apply
Headaches / Migraines
Clenching / Grinding
Facial Muscle Pain
Tooth Wear / Flattened Teeth
Neck Pain
Tooth Pain
Shoulder Pain
Snoring
Upper Back Pain
Difficulty Sleeping
Earache Pain
Chronic Fatigue / Tiredness
Clicking Joint
Sleep Study Obtained by Physician
Limited Opening
Closed Lock
Unable to Get Posterior Teeth Together
Open Lock
Treatment Plan
Comments
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.