Consultation SLEEP BETTER COLUMBUS TMJ Consult Sleep Apnea Consult Request a Benefit Analysis TMJ Consult Form Sleep Apnea Consult Name * Last Name * Phone * Email * Contact preference Phone Email Best contact time Have you been diagnosed with Sleep Apnea? * Yes No Approximate date of diagnosis Do you wear a lower denture? * Yes No Have you tried CPAP? * Yes No Medical Insurance carriers Aetna BCBS Cigna Humana UnitedHealthcare Medicare Ohio Healthy Anthem OtherOther Insurance provider phone number Do you carry a supplemental Medicare policy? Yes No Subscriber name Subscriber date of birth Subscriber ID If you are human, leave this field blank. Submit Office Address 1335 Dublin Rd, Suite 100BColumbus, OH 43215 Phone & Fax Phone: (614) 777-7350 Fax: (888) 390-0424