4975 Bradenton Avenue
Dublin, Ohio 43017
Phone: 614.766.0773
Map & Directions

ABOUT SSL CERTIFICATES

Physician Referrals

To refer a patient, you have the option of contacting us by fax, online, or by phone:

By Fax

Click here to download the referral form. Upon completion, please fax the form to (888) 491-5348.

Online

This online appointment request is a secure and confidential area. Information entered and submitted is confidential. Please refer to the personal information section in our Site Privacy Policy.

Patient Name	DOB (mm/dd/yyyy)
Patient Home Phone	Patient Work Phone	Patient Cell Phone
Primary Insurance Co.	Secondary Insurance Co.
Referring Physician	Physician Address	Physician Phone #
Person Completing Form	Contact Number
Reason for Referral Obstructive Sleep Apnea Narcolepsy Other	Restless Legs Syndrome Insomnia

Preferred Office

I certify that I am the physician or an authorized representative from the above mentioned referring physician and/or practice. I understand that Ohio Sleep Medicine Institute may call me to verify this information.

Please enter the text you see above:

By Phone

If you wish to contact us by phone, please call 614.766.0773.

adjust text size A A A

news

PATIENT PORTAL

Access our new patient portal

learn more

treatments

eXciteOSA

Tongue Muscle Stimulation

learn more

research

enroll in a research study

learn more

treatments

inap

Mask-Free Apnea Therapy

learn more

news

ebb - New Insomnia Treatment

FDA-cleared and drug-free

learn more

news

Discover INSPIRE

Upper Airway Stimulation for Obstructive Sleep Apnea

learn more

events

Historic APSS Meeting - 26th Anniversary

June 15-20, 1986 First Annual Meeting

learn more

Share the information you have learned

share now

Share this: Facebook | Twitter | digg | other networks

Ohio Sleep Medicine Institute is a comprehensive accredited sleep disorders center. Our board certified sleep specialists provide quality sleep medicine care for children and adults. Our sleep clinic offers sleep disorder evaluation, diagnosis and treatment for sleep apnea, snoring, insomnia, restless legs syndrome, periodic limb movement disorder, narcolepsy, parasomnia, fibromyalgia, chronic fatigue syndrome, shift work, fatigue, impotence or other sleeping problem. Our sleep labs services include in-clinic or home sleep study, polysomnogram test, evaluation for dental device, surgical intervention, occupational health, workplace safety and cpap therapy. We serve the communities of Columbus, Dublin, Powell, Hilliard, Upper Arlington, Delaware, Worthington, Westerville, Gahanna, New Albany, Grove City, Newark, Lancaster, Athens, Zanesville, and Mansfield in Ohio.

We use cookies and similar tracking technologies to analyze traffic and provide access to certain social media features. By accessing this website, you consent to the use of cookies, as described on our site privacy policy. I agree