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Breathe Well Sleep Solutions - Dallas Texas

Patient Forms

Welcome to our Patient Forms page, where you can conveniently access and complete the necessary paperwork prior to your visit.


Patient Forms

Streamline your visit with us by downloading and completing our essential forms. Taking a few minutes to fill out these forms in advance allows us to better understand your unique needs, ensuring a smoother and more personalized experience during your appointment. Just click on the respective forms below to get started.

Schedule Appointment

Online Patient Form

Our online patient form streamlines registration for your convenience.

Epworth Sleepiness Scale for Children and Adolescents

Our Sleep Disorder Questionnaire assists in assessing your sleep health for more effective treatment.

COVID-19 Notice

Our COVID-19 notice is in place to keep everyone informed and safe.

Current Health Profile

Your Current Health Profile helps us provide personalized care tailored to your unique needs.

Appointment & Financial Policy

Providing clear guidelines for scheduling and payment.

Online Patient Form

Please fill out this form before you come to visit us.

Medical History

Our Comprehensive Questionnaire helps us understand your child’s health for better care.


Our HIPAA form ensures the privacy of your health information.

Photo Release Form

The “Photo Release Form” gives consent to the use of their dental images

Informed Consent Oral Appliance Therapy Form

Please fill out this form before you come to visit us.

Getting started is as easy as…

Contact Us


(214) 349-9400


9757 White Rock Trail
Dallas, TX 75238


Office Hours

Monday – 8:00 – 4:00
Tuesday – 8:00 – 4:00
Wednesday – 8:00 – 4:00
Thursday – 8:00 – 4:00
Friday – 8:00 – 1:00