Free Sleep Apnea Risk Assessment

Do you find yourself feeling sleepy after lunch despite a lighter workload? Has your partner complained about your snoring during the night? Have you ever fallen asleep at the wheel? These are all signs that you may be suffering from a lack of restful sleep due to sleep apnea.

If you have concerns that you may have sleep apnea, take our risk assessment to determine if you suffer from this sleep disorder that affects your overall health. We will never share your information with third-parties. We will score your responses and our office will call you with the results.

Name*

Phone*

Email*

Gender*MaleFemale

Your Weight*

Your Height*

Your Neck Size (Inches)*

Have you been diagnosed or treated for high blood pressure?YesNo

Have you been diagnosed or treated for heart disease?YesNo

Have you been diagnosed or treated for diabetes?YesNo

Have you ever had a stroke?YesNo

Have you been diagnosed or treated for depression?YesNo

Have you been diagnosed for sleep apnea or currently using a CPAP?YesNo

How often do you smoke?

Do you wake up choking or gasping?

Have you been told that you stop breathing in your sleep or wake up choking or gasping?

Do you have problems keeping your legs still at night or need to move them to feel comfortable?

How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired?

Sitting and Reading

Watching TV

Sitting inactive in a public place (theater, meeting)

Lying down to rest in the afternoon when circumstances permit

Sitting and talking to someone

As a passenger in a car for an hour without a break

Sitting quietly after lunch without alcohol

In a car, while stopped for a few minutes without traffic