TMJ Total Joint Replacement Remote Second Opinion instructions
Discuss with your local provider why you would like to have a remote second opinion from a Penn Medicine oral and maxillofacial surgeon. After reviewing our terms and conditions with your local provider, complete the Second Opinion Consultation Request Documents and have your local provider sign them. Penn Medicine is unauthorized to provide an online remote second opinion without your local doctor’s advance approval.
Our initial consultation documents include:
- Patient Intake Form and Medical Questionnaire
- Consult Request Form
- Patient Disclaimer Form
- Payment Authorization Form
Before giving a remote second opinion, our oral and maxillofacial surgeons will need to review the following:
- A maxillofacial CT scan (face scan) that lets us see the bones of your face and neck
- A temporomandibular joint MRI, which helps us spot and diagnose joint abnormalities not seen with any other imaging method
- Reports from any previous oral or maxillofacial surgeries
- A list of any previous treatments you have had for TMJ
Complete the online Patient Intake Form. When completed, print and include it with your applicable medical records and imaging reports.
Carefully review, date, and sign the Patient Disclaimer Form. Your local provider will also need to fill out the consultation request form. We are unauthorized to provide an online remote second opinion without your local doctor’s request.
Complete the online Payment Authorization Form.
After you complete the forms, you’ll be given a direct access link to upload all requested documents via our HIPAA-secure system. The link to upload the following forms will be sent to your email address:
- Patient Intake Form and Medical Questionnaire
- Consult Request Form
- Patient Disclaimer Form
- Payment Authorization Form
Within 7 to 10 days of receipt of all required documents, we will submit your second opinion directly to your referring physician to review.