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7151 University Blvd Unit 110, Winter Park, FL 32792
(407) 636 6003
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Center for Integrative Oral Health
ABOUT US
CONTACT US
OUR PRACTICE
ORAL MEDICINE SPECIALIST
Dr. THOPPAY
TELEMEDICINE
CAREERS
TREATMENTS
MEDICAL CONDITIONS
SENIOR ORAL CARE
OROFACIAL DISEASES
BURNING MOUTH
SLEEP APNEA TREATMENT
TMJ DISORDERS
JAW/ OROFACIAL PAIN
DRY MOUTH
DENTAL PROCEDURES
ADVANCED PROCEDURES
LASER THERAPY
NEW PATIENT ENROLLMENT
FINANCIAL POLICY
PATIENT REFERRAL
PRE SURGICAL CONSULT
REFERRAL FORM
SENIOR REDUCED FEE PROGRAM
MEMBERSHIP PLANS
PATIENT INFORMATION
PATIENT PORTAL
ABOUT US
CONTACT US
OUR PRACTICE
ORAL MEDICINE SPECIALIST
Dr. THOPPAY
TELEMEDICINE
CAREERS
TREATMENTS
MEDICAL CONDITIONS
SENIOR ORAL CARE
OROFACIAL DISEASES
BURNING MOUTH
SLEEP APNEA TREATMENT
TMJ DISORDERS
JAW/ OROFACIAL PAIN
DRY MOUTH
DENTAL PROCEDURES
ADVANCED PROCEDURES
LASER THERAPY
NEW PATIENT ENROLLMENT
FINANCIAL POLICY
PATIENT REFERRAL
PRE SURGICAL CONSULT
REFERRAL FORM
SENIOR REDUCED FEE PROGRAM
MEMBERSHIP PLANS
PATIENT INFORMATION
PATIENT PORTAL
APPOINTMENT REQUEST
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This is a general form. Patients: You may register through the patient portal for secure communication. Doctors referral: Print and fax REFERRAL FORM for secure communication. Fax number: 407 636 6019
Type of appoinement
*
OFFICE VISIT NEW PATIENT
OFFICE VISIT ESTABLISHED PATIENT
TELEMEDICINE NEW PATIENT
TELEMEDICINE ESTABLISHED PATIENT
Phone number
*
Email
*
Reason appointment for
*
Emergency
Dental appointment
Senior Dental care
Sore in mouth
Sleep apnea
Oral cancer evaluation
Oral care for cancer patient
TMJ/ jaw pain
Dental pain
Gum disease
Facial pain/ Trigeminal pain
Burning mouth
Special care dental needs due to medical condition
Unknown/ rare oral problem
Preferred time
Morning 8- 11.30AM
Afternoon 1.00 -4.00 PM
Preferred day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday 9 AM- 12 noon
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