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Are you a candidate for a sleep study?

Answer the questions on this quiz, then print it using your browsers print button and then take it to your doctor to find out!

Printable Sleep Quiz

1. Do you get tired or sleepy while you are sitting, reading, watching TV or driving?
Yes No  

2. Have you been told that you snore?
Yes No  

3. Are you overweight and find it difficult to lose weight?
Yes No  

4. Are you diabetic?
Yes No  

5. Do you have high blood pressure?
Yes No  

6. Do you suffer from chest pains or shortness of breath?
Yes No  

7. Do you wake up with leg cramps or sore extremities?
Yes No  

8. Are you tired and lethargic during your work day?
Yes No  
9. Do you ever wake up with a headache?
Yes No  

10. Are you depressed?
Yes No  

11. Do you experience GI reflux at night?
Yes No  
 
If you answered "Yes" to any of these questions, you may be a candidate for a sleep study. Only your physician can make this determination and your answers to these questions will aid in determining your symptoms.
 
Order:    Baseline       Split
DX:   327.23
Physician Signature:
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Miami
5995 SW 71 Street Suite 3A, Miami, FL 33143
Office: 1.305.666.8800
Fax: 1.305.666.8801
Nashville
5211 Linbar Drive, Suite 508, Nashville, TN  37211
Office: 1.615.885.9750
Fax: 1.615.885.9751
Central Florida:
1561 W. Fairbanks Ave., Suite # 102, Winter Park, FL 32789
Office: 1.407.249.1002
 Fax: 1.407.249.1005