Think You Have OSA?

    Online Pre-Screen Tool

    Complete our on-line screening tool and your results will be emailed to you, or contact us to make an appointment to be screened at our clinic.

    Your name

    Your email

    Age

    Height(ft)

    Weight (lbs)

    Your Sex
    MaleFemale

    Category 1

    Do you snore?

    Has anyone noticed that you stop breathing during your sleep?

    Category 2

    How often do you feel tried or fatigued after you sleep?

    Have you ever nodded off or fallen asleep while driving?

    Category 3

    Do you have high blood pressure?

    Attachment(s)

    NOTE: Accept File Types: jpeg, jpg, png, and pdf.
    Up to 5 Files (Max. 3MB per file).