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Amelia Gentle Dentistry  |  Dental Sleep Medicine — Referrals for Physicians

Oral Appliance Therapy for Obstructive Sleep Apnea

A practical referral option for adult patients who can't tolerate CPAP, or who prefer an alternative therapy.

Get the Referral Forms

When to Consider a Referral

  • Diagnosed obstructive sleep apnea with CPAP intolerance or poor adherence
  • Patient prefers an oral appliance after discussion of treatment options
  • Patient needs a quiet, portable treatment option for travel or lifestyle
  • Primary snoring only, after medical evaluation has excluded OSA

What Our Sleep Program Provides

  • Comprehensive dental sleep medicine examination
  • Custom, titratable mandibular advancement device selection and delivery
  • Calibration/titration, comfort and side-effect management
  • Long-term dental and occlusal follow-up
  • Communication with the referring medical provider and coordination of efficacy verification
Custom mandibular advancement oral appliances used to treat obstructive sleep apnea
Member of the American Academy of Dental Sleep Medicine
Evidence-based, collaborative care. AASM/AADSM clinical guidance supports custom, titratable oral appliance therapy delivered by a qualified dentist for adults with OSA who are CPAP-intolerant or prefer alternate therapy. Follow-up sleep testing is recommended to confirm treatment efficacy.

Why Refer to Amelia Gentle Dentistry?

Focused dental sleep medicine care with physician collaboration
AADSM-designated dental sleep medicine provider
Multiple custom appliance options selected to fit the patient's anatomy, dentition and needs
Medical insurance billing - we help patients navigate benefits, coverage requirements and necessary documentation. Medicare-eligible cases managed per applicable coverage requirements.
Clear updates back to the referring office throughout treatment

A Simple Path for Your CPAP-Intolerant Patients

You refer, we take care of the rest — and keep you informed at every stage.

  • 1

    You Refer

    Send the referral, sleep study and relevant clinical note. We take it from there.

  • 2

    We Evaluate

    Dental sleep medicine exam, candidacy assessment and appliance selection.

  • 3

    We Treat

    Custom titratable MAD delivery, calibration and side-effect management.

  • 4

    We Communicate

    We keep your office informed and coordinate objective verification of efficacy.

  • 5

    We Follow Long Term

    Dental/occlusal monitoring, appliance maintenance and ongoing collaboration.

What Makes a Good Oral Appliance Referral?

Think of us when a patient says: “I can't wear CPAP,” “I won't travel with CPAP,” “I want another option,” or “Is there anything besides CPAP?”

What We Send Back

Concise clinical updates, including evaluation status, appliance delivery, calibration progress, complications/side effects, readiness for efficacy testing, and long-term follow-up status.

Refer a Patient

Download and complete the form(s) below, then fax them — along with the sleep study and relevant clinical note, if available — directly to our dedicated sleep fax line.

No patient information is submitted or stored through this website. Forms are downloaded, completed offline, and sent by fax to protect patient privacy.
Form 1

Quick Sleep Referral

Click here to download the Quick Referral Form Preview of the Quick Sleep Referral form Click to download
Form 2

OAT Prescription & Medical Necessity Form

Click here to download the Clinical Note form Preview of the OAT Prescription and Medical Necessity form Click to download
Send Referrals To
Dedicated Sleep Fax: (904) 85-SLEEP / (904) 857-5337
Amelia Gentle Dentistry  |  1699 S 14th St #21, Fernandina Beach, FL 32034  |  (904) 277-8500

A physician or other qualified treating practitioner should diagnose OSA and prescribe/coordinate treatment. Medicare coverage for a custom mandibular advancement device has specific evaluation, sleep-test, and documentation criteria.