INFORMATION FOR DOCTORS AND OTHER HEALTH CARE PROFESSIONALS
Now with 2 locations
La Salle serving Winnipeg and Eastern Manitoba: 204-736-4399
Portage La Prairie serving the Portage area and Western Manitoba: 204-814-0111

Orthodontics and Orthopedics

Download our Orthodontics and Orthopedics Questionnaire here: Download

Once you download the form, and fill it out, please drop it by our office, or fax it back to us!
If you have any questions regarding the form, please do not hesitate to contact us via the methods below.

Fax back completed questionnaire to:
Fax: (204) 927-8659

Drop off completed questionnaire at:
245-3025 Portage Ave
Winnipeg, MB, R3K 2E2

moc.y1739114901pareh1739114901taenp1739114901apeel1739114901sjmt@1739114901ofni1739114901
http://www.tmjsleepapneatherapy.com

If you have any questions call:
Phone: (204) 927-8650

© 2025 - The TMJ & Sleep Therapy Centre
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New Patient Forms

Use our Online Patient Questionnaire:  LAUNCH IT HERE!

Patient Questionnaires:

DOWNLOAD - our TMJ and Sleep Apnea Questionnaire

DOWNLOAD - our Functional Orthodontics and Orthopedics Questionnaires

Referral Forms:

DOWNLOAD - our Adult TMD, Snoring & Sleep Apnea form

DOWNLOAD - our Pediatric TMD & Airway form

  • Scan and e-mail it to: ac.gn1570397810irons1570397810jmt@o1570397810fni1570397810
  • Portage La Prairie & Western Manitoba
    • Fax forms to: 204-814-0133
    • Or drop it off at: unit 105 140-9th Street, Portage La Prairie, Mb, R1N 3V5
  • Winnipeg & South Eastern Manitoba
    • Fax forms to: 204-736-8210
    • Or drop it off at: 4-49 Rue Principale, La Salle, MB R0G 0A2

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