Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
*
Yes
No
Do you often feel tired, fatigued, or sleepy during the daytime?
*
Yes
No
Has anyone observed you stop breathing during your sleep?
*
Yes
No
Do you have or are you being treated for high blood pressure?
*
Yes
No
Is your BMI more than 35? (See below to calculate your BMI)
*
Yes
No
Is your age over 50?
*
Yes
No
Is your neck circumference larger than 16 inches?
*
Yes
No
Are you male?
*
Yes
No
If you're diagnosed with sleep apnea and the physician orders sleep equipment for you, would you like Apria to provide your equipment and related supplies?
*
Yes please!
No, I'd rather figure it out on my own.
Your name
First Name
Last Name
Your email
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Your phone number
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Your score
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