Health Questionnaire

Our treatment approach helps us personalize your course of care. Please be copmlete and accurate with your responses so we can be best informed about your therapy options.

Personal Information

This information should be filled out based on the person that will take the Home Sleep Test.

Epworth Sleepiness Scale

How sleepy do you feel in the following situations?

Medical History

Do you have or have you ever experienced the following conditions?

Sleep Apnea Assessment

Please answer the following questions to the best of your ability.