Do you suffer from Sleep Apnea? Answer this sleep apnea questionnaire to find out STOPDo you Snore loudly (louder than talking or loud enough to be heard through closed doors)?S Yes No Do you often feel Tired, fatigued, or sleepy during 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 BANGBMI more than 35kg/m2? Yes No Age over 50 years old? Yes No Neck circumference > 16 inches (40cm)? Yes No Gender: Male? Yes No Count how many times you answered "yes" to the questions above. High risk of OSA: Yes 5 - 8 Intermediate risk of OSA: Yes 3 - 4 Low risk of OSA: Yes 0 - 2 Would you like to schedule an appointment? Yes Name First Last Email* Phone*Office Preference?Leesburg / LansdowneRestonIf you have filled out the information above, someone from our office will contact you about setting an appointment at one of our convenient locations. CAPTCHAMessage Δ
