4975 Bradenton Avenue
Dublin, Ohio 43017
Phone: 614.766.0773
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ABOUT SSL CERTIFICATES

Physician Referrals

To refer a patient, you have the option of contacting us by fax, online, or by phone:

By Fax

Click here to download the referral form. Upon completion, please fax the form to (888) 491-5348.

Online

This online appointment request is a secure and confidential area. Information entered and submitted is confidential. Please refer to the personal information section in our Site Privacy Policy.

Patient Name	DOB (mm/dd/yyyy)
Patient Home Phone	Patient Work Phone	Patient Cell Phone
Primary Insurance Co.	Secondary Insurance Co.
Referring Physician	Physician Address	Physician Phone #
Person Completing Form	Contact Number
Reason for Referral Obstructive Sleep Apnea Narcolepsy Other	Restless Legs Syndrome Insomnia

Preferred Office

I certify that I am the physician or an authorized representative from the above mentioned referring physician and/or practice. I understand that Ohio Sleep Medicine Institute may call me to verify this information.

Please enter the text you see above:

By Phone

If you wish to contact us by phone, please call 614.766.0773.

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PATIENT PORTAL

Access our new patient portal

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treatments

eXciteOSA

Tongue Muscle Stimulation

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treatments

inap

Mask-Free Apnea Therapy

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news

ebb - New Insomnia Treatment

FDA-cleared and drug-free

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news

Discover INSPIRE

Upper Airway Stimulation for Obstructive Sleep Apnea

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events

Historic APSS Meeting - 26th Anniversary

June 15-20, 1986 First Annual Meeting

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Ohio Sleep Medicine Institute is a comprehensive accredited sleep disorders center. Our board certified sleep specialists provide quality sleep medicine care for children and adults. Our sleep clinic offers sleep disorder evaluation, diagnosis and treatment for sleep apnea, snoring, insomnia, restless legs syndrome, periodic limb movement disorder, narcolepsy, parasomnia, fibromyalgia, chronic fatigue syndrome, shift work, fatigue, impotence or other sleeping problem. Our sleep labs services include in-clinic or home sleep study, polysomnogram test, evaluation for dental device, surgical intervention, occupational health, workplace safety and cpap therapy. We serve the communities of Columbus, Dublin, Powell, Hilliard, Upper Arlington, Delaware, Worthington, Westerville, Gahanna, New Albany, Grove City, Newark, Lancaster, Athens, Zanesville, and Mansfield in Ohio.

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