Referral Info

Thank you for your interest.  A Medical Prescription is required to Provide Oral Appliance Therapy to manage Sleep Apnea. Signing the referral slip will satisfy this criteria.

Please call our office or submit the form found on the link below.

For Immediate Physician Referral Form Download Click Here

Please submit form to right to have An Information package including referral forms sent to you. If special materials are needed please indicate in Message section.

non-physician referrals are welcome.Please call, FAX, or email our office with your referral requests.

phone: 905 212 7732 . - fax: 905 212 7736 . - info@DrViviano.com

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