Header
Sales Rep
For more information provide your e-mail address
 

Free Sleep Apnea Survey: Get Your Sleep Score

Sleep Apnea can be a serious condition. This free service is for people like you who are interested in having their answers reviewed by a physician at absolutely no charge. Therefore, the physician will require some basic information in case your questionnaire results are positive and you need to be contacted regarding your options. Of course, your results and information are considered private and protected information under Federal and State laws.

Contact Information

To get your sleep score, please complete the form below, and your score will be e-mailed to you.

Please note that your information is confidential, and will not be shared with anyone. Giving us your e-mail will not result in spam or junk e-mail.

**All fields are required.

  

     

Snoring

Do you snore on most nights (more than 3 times/weeks)?

Is your snoring loud (can it be heard through a door or wall)?

Breathing

Has it ever been reported to you that you stop breathing or gasp during sleep?

Neck Size

Male:

Female:

Blood Pressure

Have you had, or are you currently being treated for, high blood pressure?

Dozing Off

Do you occasionally doze or fall asleep during the day when:

You are not busy or active?

You are driving or stopped at a light?