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:, and our staff will contact patient with an appointment time!

Patient Referral FormsFill Out Online

If you do not have AdobeReaderĀ® installed on your computer, Click Here To Download.

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