Refer a Patient to Oregon TMJ
We welcome referrals from physicians, dentists, oral surgeons, and other healthcare providers. Download our referral form below.
Oregon TMJ Physician Referral Form
Complete the form and fax it to (503) 788-8020, or give it to your patient to bring to their first appointment. The form covers referring provider information, patient demographics, insurance, reason for referral, prior treatments, and imaging history.
Download Referral Form (PDF)PDF format · Print and fax to (503) 788-8020 · Do not submit electronically
About Oregon TMJ
A Conservative, Non-Surgical Approach to TMJ Care
Oregon TMJ is a chiropractic-focused clinic treating patients with temporomandibular joint disorder (TMJD). Led by Dr. Kevin Segal, DC, we provide a whole-body, biomechanical approach to jaw pain — treating the muscles, joints, cervical spine, and posture that drive TMJ symptoms.
We are an appropriate referral destination for patients who have not responded to dental appliances or bite adjustment, patients seeking a non-surgical alternative before considering joint surgery, and patients whose jaw symptoms appear connected to cervical spine dysfunction, forward head posture, or chronic muscle tension.
How to Refer
Simple Referral Process
Download & Complete the Form
Download the referral form above. Complete provider and patient sections. Insurance information is helpful but not required.
Fax to (503) 788-8020
Fax the completed form directly to our office. Alternatively, give the form to your patient to bring to their first appointment.
Patient Schedules Their Appointment
Your patient can book online via our website or call (503) 774-8525. We will follow up with a report of findings upon request.
Provider Contact
Tuesday & Friday — available by text, voicemail, or email
Insurance Accepted
Note: Some insurance plans may only cover the spinal care portion of the visit. TMJ-specific care may not be covered under all plans. Patients should verify benefits prior to their appointment.
Questions About a Referral?
Call our office directly. We are happy to discuss whether a patient is an appropriate candidate for chiropractic TMJ care.