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: info@dallastmjdr.com), and our staff will contact patient with an appointment time!

Patient Referral Forms – Fill Out Online

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We encourage you to contact us at (817) 251-9985 or info@dallastmjdr.com if you have any questions, need more information regarding our services/treatments.