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Patient Referral Forms

You may download and complete the form below to refer a patient to Dr.Virk's Orofacial Pain, TMJ and Sleep Apnea/Snoring practice in Southlake, TX. Please fax/e-mail the referral form along with any pertinent patient records to 817-500-9672 (e-mail: [email protected]), and our staff will contact patient with an appointment time!

Patient Referral Form

We encourage you to contact us at (817) 251-9985 or [email protected] if you have any questions, need more information regarding our services/treatments.

Appointment Request

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Our Location

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Hours of Operation

Our Regular Schedule

Monday:

Closed

Tuesday:

9:00 am - 3:00 pm (administrative hours only)

Wednesday:

8:00 AM- 5:00 PM

Thursday:

8:00 AM-5:00 PM

Friday:

8:00 AM-5:00 PM

Saturday:

By appointment only

Sunday:

Closed