Sleep Questionnaire

Please correct the errors described below.

A good sleep is important to your well-being. Since most people spend roughly 1/3 of their lives asleep, it is easy to see how the quality of sleep directly affects the quality of your life. One in 3 Americans has a sleep disorder making sleep/waking hours miserable. Many of these people suffer needlessly because they are unaware that a problem exists. Once detected, most sleep disorders can be corrected. If you have experienced any of the following symptoms in the last year, check the box YES. When referring to night, assume that this means during your sleep period.

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Questions about your habits:

Please provide information for the following procedures:

If yes, bring your compliance card/PAP machine to the office

Family medical information

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