Adult Sleep Questionnaire

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    Save time at the doctor's office and fill out your registration and health history information online! Take a few minutes to fill out this confidential form and click "submit". Your information will be sent to our office with secure encryption. We will have your information when you arrive for your first appointment.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Instructions: Is it possible that you have Obstructive Sleep Apnea (OSA)? Please answer the following questions to determine if you are at risk.

  • Snoring?

  • Tired?

  • Observed?

  • Pressure?

  • Body Mass Index

    Please calculate your BMI using this online tool: Body Mass Calculator

  • Age

  • Neck Size

    For male, is your shirt collar 17 inches or larger?

    For female, is your shirt collar 16 inches or larger?

  • Gender

  • For general population...

    OSA - Low Risk: Yes to 0-2 questions

    OSA - Intermediate Risk: Yes to 3-4 questions

    OSA - High Risk: Yes to 5-8 questions

    Or Yes to 2 or more STOP questions + Male Gender

    Or Yes to 2 or more STOP questions + BMI > 35

    Or Yes to 2 or more STOP questions + Large Neck