805.557.9930
FacebookTwitterYoutubeRSS

OSA QUIZ

Please complete the form below and click “Submit” to send it to us. We will be in touch with you shortly. If you would prefer to download the form in PDF format and send it to us, please CLICK HERE to do so. Thank you.

We care about your privacy. To see our Privacy Policy CLICK HERE.

Please Answer All Questions

General information
  1. (required)
  2. (valid email required)
  3. (required)
  4. (required)
  5. (required)
  6. (required)
A Simple 5 Question Screening
  1. Do you snore?
  2. Are you excessively tired, fatiqued, lethargic, or have a lack of energy during the day?
  3. Have you ever been told that you stop breathing during sleep?
  4. Do you have a history of hypertension?
  5. Is your neck size larger than 17 inches (males) or larger than 16 inches (females)?
 

A “Yes” answer to two or more of the above questions is a Positive Screen for OSA and warrants further evaluation. We encourage you to CONTACT US now to schedule your consultation.