Do I have Sleep Apnea?

Please fill out the form below for a free sleep apnea assessment!

Our treatment coordinator will be in touch with you to discuss your answers and associated sleep apnea risk profile.  We will provide critical information about sleep apnea testing and treatment alternatives, costs and insurance coverage.

Sleep Apnea Quick Test

"*" indicates required fields

Screening Question #1 - Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?*
Screening Question #2 - Do you often feel tired, fatigued, or sleepy during the daytime?*
Screening Question #3 - Has anyone observed you stop breathing during your sleep?*
Screening Question #4 - Do you have or are you being treated for high blood pressure?*
Snoring Frequency?
Have you previously been diagnosed/tested for sleep apnea?
If yes, are you currently under treatment?
If you are receiving treatment, what type?

Do you have Extended Health Insurance
Age Range
Name*