Your Name
    Your Email
    Phone Number
    Your Date of Birth

    The questionnaire below is a common tool for screening your risk-level for Obstructive Sleep Apnea. Answer the questions honestly and see your risk level immediately below.

    Snoring: Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

    YesNo

    Tired: Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during during driving or talking to someone)?

    YesNo

    Observed: Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

    YesNo

    Pressure: Do you have or are being treated for High Blood Pressure?

    YesNo

    Body Mass Index more than 35 kg/m2?

    YesNo

    Age older than 50 years?

    YesNo

    Neck size large? For males, is your shirt collar 17 inches or larger? For females, is shirt collar 16 inches or larger?

    YesNo

    Gender = Male?

    YesNo

    OSA Risk Level: