Sleep Apnea Assessment

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utm_campaign

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utm_source

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Do you snore loudly, louder than when you speak normally, or is it only loud enough to be heard outside the room?* This field is required.

YESNO

4

Do you often feel fatigued, tired, or sleepy during the daytime?* This field is required.

YESNO

5

Has anyone ever noticed if you stop breathing while you sleep?* This field is required.

YESNO

6

Do you have high blood pressure, or are you currently being treated for hypertension?* This field is required.

YESNO

7

Is your body mass index (BMI) greater than 35?* This field is required.

YESNO

8

Are you over 50 years old?* This field is required.

YESNO

9

Date of birth* This field is required.

10

Gender* This field is required.

Male

Female

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Weight/Height* This field is required.

Weight / Kilogram

Height / Centimeter

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Is your neck circumference more than 40 cm?* This field is required.

YESNO

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Full name* This field is required.

Prefix

First name

Last name

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Email* This field is required.

example@example.com

Confirm Email

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Phone number* This field is required.

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* This field is required.

17

18

Total