CPAP Consent

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CPAP Consent

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CPAP Intolerance Consent

Affidavit For Intolerance to CPAP
Full Name*
First Name Last Name
I have attempted to use nasal CPAP to manage my sleep related breathing disorder (apnea) and find it intolerable to use on a regular basis for the following reason(s):
- Mask leaks
- Mask uncomfortable/Device uncomfortable
- Unable to sleep comfortably
- Noise disturbs my sleep and/or bed partners sleep
- Restricts movement during sleep
- Does not seem to be effective
- Straps/headgear cause discomfort
- Pressure on the upper lip cause tooth related problems
- Other
If other, explain
Because of my intolerance/inability to use CPAP I wish to have an alternative method of treatment. That form of therapy is an Oral Airway Dilator appliance, as prescribed to me by Dr. Wall.
Signature*
Date*
MM slash DD slash YYYY
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Dental Solutions, Inc
Dr. Judson Wall
235 S 400 E
Bountiful, UT
84010
Phone: (801) 298-1812

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Dr Montes seen both of my kids and was absolutely amazing, they felt no pain, very comfortable the whole time. They loved it there! They were both scared to go and now they both can't wait to go back!

Kierston Kirby

May 24, 2022.

I feel very fortunate to have found Dental Solutions. The dentists and the staff are outstanding! I have had health issues for many years and had this underlying, nagging feeling that was just exhausting. I went to Dental Solutions and had cavitation surgery and other dental work clean up, and that underlying nagging feeling is gone and my energy has returned! I would highly recommend them.

Tina Clifford

June 28, 2021.

The doctors and supporting staff are wonderful, and have helped me take control of my health through corrective dental work. It’s so nice to have a consultation with professionals who really care about you and your life!

Bonita Richins

June 18, 2021.

Dr Montes is a very knowledgeable dentist, and the whole staff is very fun and professional.

Coz

June 14, 2021.

The doctors and staff at Dental Solutions are exceptional. I have been going since 2015 and have received the best of care. Dr. Wall is a great dentist with much knowledge and expertise. He and the staff make sure you are comfortable and have all your questions answered. Kris is the best and most thorough hygienist. Highly recommend!

Marianne Austin

June 2, 2021.

Dr. Wall is a living legend in our family! He has helped me recover from poorly done root canals, fixed years worth of incorrect orthodontics, and solved my TMJ problems. I struggled with chronic vertigo during and after my pregnancy that was passed off as “normal” hormonal changes. I saw multiple doctors and neurologists before visiting Dr. Wall. He discovered 4 cavitations that needed addressing and once he worked his dental magic, the vertigo I had struggled with daily for 2 years disappeared! The importance of proper dental care for overall health cannot be overlooked. Dr. Wall is the best in his field and it’s an honor to have him on my healthcare team!

Missy Beavers

May 26, 2021.

I highly recommend Dr. Wall to anybody with tooth aches or pains. He is so caring and understanding. He has genuine concern for my well being. His staff is very nice and professional. I can't say enough good things about the care I received from Dr. Judson Wall and his team. Thank-you!

Tyler Heath

May 26, 2021.

I had so much discomfort for years and Dr Wall took out teeth that were gangrene that I did not know were that bad. He is amazing....

Beatrice Ireland

May 24, 2021.

Hands down the most amazing dentist I've ever been to. From the expertise of care and heartfelt communication from Dr. Wall and his staff to the lush jungle of plants throughout the office, this is a dental experience like no other. For 15 years I had been struggling with a phantom disease causing chronic fatigue, brain fog, anxiety, depression, etc...it was hell. A woman (who I now feel is certainly a guardian angel) brought to my attention that my story was almost identical to the man who produced the film "Root Cause". I was taken aback that my issues could actually be caused by an old root canal I had and felt compelled to watch it...it made me cry and I knew this was it. She then referred me to Dr. Wall and the rest is history. I spent about 4 hours at Dental Solutions my first visit where I received a level of care you wouldn't expect from a dentist, let alone your family doctor. Being a biological practice, Dental Solutions has your whole body in mind and I was tested from head to toe to figure out what was going wrong. Sure enough, I had a failed root canal that had eaten a 1 cm diameter hole in my jaw above that tooth...it was slowly killing me. Dr. Wall pulled the decayed tooth which was gangrenous, cleaned everything out, stuffed the decayed hole with platelet rich fiber (PRF) and put a zirconia implant in. He also cleaned out my wisdom tooth cavitations and did TMJ injections to help the jaw issues I didn't realize I had. Over one year later and I feel better than ever, I have my vitality back!!!! So very thankful for Dr. Wall, he saved my life. No other dentist had any idea what was going on. This is the place to go, I travel from Colorado to come here...highly recommend this practice. Thank you Dental Solutions for changing my life!

Alex Curry

May 13, 2021.

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235 South 400 East, Bountiful, Utah, 84010