Patient Portal

Sleep Apnea Survey

This free 15 second quiz can help save your life!

Don't hesitate, find out if you're at risk now!

"*" indicates required fields

Have you been told that you Snore or know that you Snore/make breathing noises while sleeping?*
Do you often feel Tired, fatigued or sleepy during the day?*
Has anyone Observed you stop breathing during sleep?*
Do you have or have you been treated for High Blood Pressure?*
Is your Body Mass Index (BMI) more than 35 lbs/in²?*
- Not Sure? Click here for BMI Conversion Chart
Is your Age more than 50 years old?*
Is your Neck circumference greater than 16 inches?*
Is your Gender male?*

PLEASE FILL OUT THE SHORT FORM BELOW AND WE WILL EMAIL YOU THE RESULTS.

Name*