ROCKVILLE SLEEP SOLUTIONS
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Risk Quiz
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Sleep Apnea Risk Quiz
Fill and submit the following brief questionnaire, and our specialists would determine if you might be at risk for sleep apnea.
Information will be securely delivered to our sleep apnea specialists, and will not be shared with any third party.
At night, do you…
*
Snore?
Wake up gasping or choking?
Grind your teeth?
Stop breathing while sleeping?
Awaken frequently?
Wake up frequently to urinate?
None of the above
During the day, do you…
*
Feel sleepy or unintentionally doze?
Have difficulty with memory or concentration?
Breath through your mouth?
Have headaches in the morning?
Awake tired even after a full night's sleep?
None of the above
At-risk checklist
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Overweight or obese
High blood pressure
Neck size > 17 (men), or >15 (women)
Acid reflux or heartburn
Type II Diabetes
Depression
Coronary Artery disease
Congestive heart failure
Stroke
Insomnia
Erectile Dysfunction
None of the above
Check all that apply
*
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Name
*
First
Last
Email
*
Phone Number
*
Further Comments?
*
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Home
Contact
Risk Quiz
Educational