Referral to Dr. Levy

MD Referral Form (PDF)

Patient Referral Form

In order for us to submit to medical insurance and insure a smooth process for the patient, we will require a prescription/referral from your office. If the patient has Medicare as their primary insurance, they must have a face to face encounter to obtain the referral. Please make sure the following is included on the Rx/referral:

Patient name
“Please evaluate for oral appliance therapy for G47.33”
“Patient is CPAP Intolerant and oral appliance therapy is medically necessary to treat obstructive sleep apnea.”

If you wish to fax it to our office, the fax number is 888-390-0424. Alternatively, the patient may bring it to his/her consult with Dr. Levy. Thank you for your cooperation and assistance in helping this patient obtain treatment for their sleep apnea.

Complete the form and we will contact the patient to schedule a consult with Dr. Levy

We have moved!

Please make a note of our new address.

1335 Dublin Rd, Suite 100B
Columbus, OH 43215
PH: (614) 362-7292

** If you do not use our zip code in your GPS, you will not be directed to our office.

We are located in Grandview, WE ARE NOT IN DUBLIN– Riverside Drive is the same as Dublin Rd/33, the name of the road changes after you cross over W.5th Ave. We are next door to ABC/6/FOX. Entrance to our suite is located at the front of the building, by the road.