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Dream Sleep

Fill out this form to to determine your risk for sleep apnea and sleep-related breathing disorders.

Determine your risk for OSA

    Please answer the following questions below to determine if you might be at risk.

    YesNo

    Do you snore loudly or have you been told you snore loudly?

    YesNo

    Do you experience daytime sleepiness or drowsiness? Do you suffer from fatigued driving?

    YesNo

    Have you ever stopped breathing while sleeping or been observed choking/gasping for air while sleeping?

    YesNo

    Do you have high blood pressure?

    Body Mass Index Calculator

    Please populate both the height and weight fields in order to calculate BMI

    Height (in)

    Weight (lb)

    YesNo

    Is your BMI higher than 35?

    YesNo

    Are you over the age of 50?

    YesNo

    Do you have a large collar size? (Measured around Adams apple) For male, is your shirt collar 17 inches / 43cm or larger? For female, is your shirt collar 16 inches / 41cm or larger?

    YesNo

    Are you male?


    Zip Code (required)

    By clicking below you acknowledge that you are sharing anonymous screening information, including your zip code with DreamSleep.

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      Please fill out the form below if you wish to be matched with a DreamSleep Certified Provider in your area.

      First and Last Name (required)

      Phone Number (required)

      Email (required)

      Zip Code (required)

      Symptoms:
      SnoringWaking during the nightGasping for airDaytime sleepinessFrequent napsDry Mouth or Sore ThroatHeadaches in the MorningDifficulty ConcentratingForgetfulnessDepressionFeeling IrritableNight SweatsRestless SleepOther

      By clicking "Continue" below I acknowledge that I am sharing my contact information, zip code, symptoms and screening assessment with DreamSleep and that a DreamSleep Certified Provider may contact me to schedule a follow up appointment. (required)

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      Call Today For A Consultation: 1-844-363-7533

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