Sleep Survey

Please fill out the short survey below and we will contact you with the results.

    Do you Snore loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

    Do you often feel Tired, fatigued, or sleepy during the daytime (such as falling asleep during driving or talking to someone)?

    Has anyone Observed you stopping breathing or choking/gasping during your sleep?

    Do you have or are being treated for high blood Pressure?

    Body Mass Index (BMI) more than 35kg/m2? (How to calculate your BMI?)

    Is your Age older than 50?

    Is your Neck circumference > 16" (Measured around Adams Apple)

    Is your Gender male?

    Your contact information: