Questionnaire - ApnoMed

ApnoMed
Sleep Questionnaire

Do you snore at nights?

Do you stop breathing while asleep or gasp for air?

Are you tired during the day?

Do you have morning headaches?

Do you have difficulty staying asleep?

Do you have difficulty paying attention during the day?

Full Name

Tel:

Zip Code

ApnoMed, Inc. is a developer of patented, FDA-cleared medical devices and treatment protocols to prevent, manage and treat patients suffering from obstructive sleep apnea, a life-threatening condition where patients stop breathing while asleep.

ApnoMed
Sleep Questionnaire

PATIENTS

PROVIDERS

APNOMED

Congratulations!

You are one step
closer to a better nights sleep

YES
NO

YES
NO

YES
NO

YES
NO

YES
NO

YES
NO

ApnoMedSleep Questionnaire

PATIENTS

PROVIDERS

APNOMED

Congratulations!

You are one step closer to a better nights sleep

ApnoMed
Sleep Questionnaire

You are one step
closer to a better nights sleep