TMJ & Orofacial Pain Treatment Centers of Wisconsin

We have 5 convenient locations throughout Wisconsin. In addition we are covered by most of the medical insurance companies and HMO’s in the state of Wisconsin.

Please fill out the form below to send us a message:

First name:

Last name:

Date of birth:

Address:

City:

Zip code:

State:

Email: *

Phone:

Patient's name, if appointment is not for you:

Location you would like to be seen at:

How did you hear about us?

Prepare for your Visit

In order to help you arrive well prepared for your office visit at TMJ & Orofacial Pain Treatment Centers, we have the necessary office forms here for you to print out and complete prior to your visit.

If you are unable to print the forms, simply arrive a few minutes early to your visit; we will have these forms available in the office for you.

Patient Forms

New Patient Registration Form (PDF)
Authorization for Disclosure of Patient-Identifiable Health Information (PDF)

Request an Appointment

We have 5 convenient locations throughout Wisconsin. In addition we are covered by most of the medical insurance companies and HMO’s in the state of Wisconsin.

Prepare for your Visit

Patient Forms