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PATIENT PORTAL
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(302) 239-1757
Pain & Sleep Therapy Center
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VIVOS Therapeutics
Sleep Disorders
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Symptoms
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Infant Frenectomy
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Myofunctional Therapy
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Events & Wellness Workshops
Contact
Contact
Careers
Referring Patients
Meet Us
Dr. Robinson
Dr. Jacobs
Dr. Green
Meet the Team
Technology
Testimonials
Events
Careers
TMJ/Head & Facial Pain
Symptoms
Diagnosis
Treatment
Pain Survey
Sleep Disorders
Symptoms
Diagnosis
Treatment
Sleep Survey
Sleep Appliances
Pediatrics
Airway/Facial Development
Advanced Lightwire Functional Appliance (A.L.F.)
VIVOS Therapeutics
Sleep Disorders
Symptoms
Diagnosis
Treatment
TMD/Head & Facial Pain
Symptoms
Diagnosis
Treatment
Frenectomy
Infant Frenectomy
Child/Adult Functional Frenuloplasty
Myofunctional Therapy
Events & News
In The News
Newsletter & Blogs
Events & Wellness Workshops
Contact
Contact
Careers
Referring Patients
Wellness Workshop Survey
WELLNESS WORKSHOP SURVEY
I am most interested in my:
*
Structural / Physical Health
Emotional / Spiritual Health
Chemical / Nutritional Health
I spend _____ a week taking care of my Structural / Physical Health.
*
1-3 Hours
3-6 Hours
6 + Hours
This includes but not limited to cardiovascular exercise (walking/jogging/running), yoga, weight lifting, recreational sports (basketball, soccer) and physical therapy.
I am:
*
Happy with the amount of time I dedicate to my Structural / Physical Health.
Would like to increase my time to my Structural / Physical Health.
I spend _____ a week taking care of my Emotional / Spiritual Health.
*
1-3 Hours
3-6 Hours
6 + Hours
This includes but not limited to worship, meditation, recreational reading, counseling and volunteering.
I am:
*
Happy with the amount of time I dedicate to my Emotional/Spiritual Health.
Would like to increase my time to my Emotional/Spiritual Health.
I spend _____ a week taking care of my Chemical / Nutritional Health.
*
1-3 Hours
3-6 Hours
6 + Hours
This includes but not limited to meal planning and prepping (healthy foods of course), nutritional research/counseling and related events.
I am:
*
Happy with the amount of time I dedicate to my Chemical / Nutritional Health.
Would like to increase my time to my Chemical / Nutritional Health.
PLEASE FILL OUT THE SHORT FORM BELOW AND WE WILL BE IN TOUCH.
I would most likely attend an event on the following topic:
*
Structural / Physical Health
Emotional / Spiritual Health
Chemical / Nutritional Health
I am also interested in learning more about Pediatric Sleep Disordered Breathing*
*
Yes
No
Name
First
Last
Email
Phone
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