ONLINE PATIENT FORMS

Below are links to online forms for potential and current patients. Please fill out the appropriate form(s) after contacting Revive.

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Comprehensive Sleep History

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Comprehensive TMD/Pain History

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Comprehensive Medical History

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Comprehensive Pediatric History

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Comprehensive Orthodontic History

Comprehensive Lactation History (coming soon)

Monday: 10am - 6pm

Wednesday: 12pm - 8pm​​

​Saturday: 9am - 1pm

Online Therapy Sessions Available!

500 N. Rainbow Blvd, Ste. 315

Las Vegas, NV 89107

Located inside Valley Smile Solutions

revivegrowsleepbreathe@gmail.com

Tel: 702-763-7429

© 2020 by Revive Orofacial Therapy and Wellness Center