Choose Your Path to Healing
AMD Connection

Thank you for reaching out to us! We truly appreciate your patience and trust. We are committed to providing you with the best possible care, and we want to be fully transparent with you.

After one podcast, over 300 patients like you reached out, seeking help for symptoms like pain, fatigue, sleep issues, and more—linked to Impaired Mouth Syndrome (IMS). But the truth is, we don’t yet have enough trained Airway Mouth Doctors (AMDs) to help everyone immediately.

This new form will help us better understand your needs and connect you with the right solution. Your responses will guide us in offering you the best options available.

Please Complete the Updated Form Below:

First Name

Last Name

Phone *

Email *

Have you previously completed the Impaired Mouth Syndrome Score Test?

Yes

Do you currently have your airway, sleep, or dental health records?

Are you willing to travel for treatment with a certified AMD?

Would you like your case to be mentored by a certified AMD (if a local AMD is not available)?

If you chose: Send the Patient Referral Kit to My Dentist, please leave their name, phone number and email

I agree to receive communications regarding AMD options and understand that my information will be used to provide me with the best possible care.

I understand that if a local AMD is not available, I may be offered options such as traveling, mentorship, or referring my dentist.