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)?SYesNoDo you often feel Tired, fatigued, or sleepy during daytime?YesNoHas anyone Observed you stop breathing during your sleep?YesNoDo you have or are you being treated for high blood Pressure?YesNoBANGBMI more than 35kg/m2?YesNoAge over 50 years old?YesNoNeck circumference > 16 inches (40cm)?YesNoGender: Male?YesNo 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?YesName 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
