BCOH Sleep Apnea Referral Referrals For physicians who want to refer their patients to our office for treatment for sleep apnea, please download and fill out our referral form. Patient's Information Your Name (required) Patient's Email Your Email (required) Patient's Address Patient's Phone Number Patient's DOB Requesting Physician's Information Sleep Study Available: YesNo Reason for referral (Mark all that apply) Diagnosis: Obstructive Sleep Apnea (ICD 327.23)Hypersomnia due to Sleep Apnea (ICD 780.53)Insomnia due to Sleep Apnea ( ICD 780.51)Other , unspecified (ICD 780.57) Baseline Data (without CPAP or Oral Appliance) AHI RDI Lowest Desaturation (SpO2) T90 Therapies attempted: CPAP IntolerantNot a good candidate Surgery YesNo Note: Please Clear your Browser's Cache if unable to Submit Request A PresentationFor physicians want to learn more about oral appliance therapy, please request a presentation by contacting us.Phone: (617) 536-4620Email: bcoh@bcoh.com