When Dental
Excellence Matters

Sleep Survey

Let’s Get To Know Each Other

Step 1 of 3

Tell us about yourself

Let’s find out about the physical characteristics that affect your health.

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Your gender *

Your neck size *

in

Save Answers

Step 2 of 3

Have you been diagnosed or treated for:

Select any condition you have been treated for:

Step 3 of 3

Feeling sleepy?

How likely are you to doze off or fall asleep (more than just feeling tired) in the following situations?

Try to think about how these things would typically affect you.

Activity
No
Yes

Do you snore more than 3 nights per week? *

Have you, your partner, or a family member noticed or commented on your loud snoring? *

Has anyone told you that you stop breathing while you are sleeping? *

Do you often experience fatigue or sleepiness in the daytime? *

Do you have difficulty remembering things or concentrating? *

Risk of potential Sleep Apnea

Obstructive Sleep Apnea has been linked to heart disease, COPD, stroke, diabetes and cancer and its effects range from daytime sleepiness, depression, relationship issues and dementia.

If you scored 2 points or higher contact us today about being tested for obstructive sleep apnea.

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Points

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