New Patient Offer
Chadds Ford Dentist Special Offer

Get A Radiant Smile On Us
We offer a variety of
whitening techniques tailored to your needs

(Free Whitening - $99 Value upon completion of
exam and cleaning)

New patients, complete the form below or call our office to take advantage of this offer by: 03/26/2023

Not to be combined with another offer. New patients only.

Call today: 610-558-1760


Chadds Ford Dentist Special Offer

Get A Radiant Smile On Us
We offer a variety of
whitening techniques tailored to your needs

(Free Whitening - $99 Value upon completion of
exam and cleaning)

New patients, complete the form below or call our office to take advantage of this offer by: 03/26/2023

Not to be combined with another offer. New patients only.

Call today: 610-558-1760


Sleep Apnea Questionnaire

Simply complete the form below and someone from our dental team will contact you soon.

S: Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
Yes No
T: Do you often feel tired, fatigued or sleepy during the day?
Yes No
O: Has anyone observed you not breathing during sleep?
Yes No
P: Do you have or have you been treated for high blood pressure?
Yes No
You have a high risk of sleep apnea if you answered “yes” to two or more of these questions.
B: Is your Body Mass Index more than 35 kg/m2?
Yes No
A: Is your age more than 50 years old?
Yes No
N: Is your neck circumference greater than 40 cm?
Yes No
G: Is your gender male?
Yes No
You have a high risk of sleep apnea if you answered “Yes” to three or more of the eight STOP-Bang questions.
Name:
Email:
Date:
Phone:
Please enter code above in the field below.

Office Hours:

  • Monday 08:00am - 04:00pm
  • Tuesday 09:00am - 04:00pm
  • Wednesday 09:00am - 04:00pm
  • Thursday 07:30am - 04:00pm
  • Fridays Select

610.558.1760

Office Tour