Forms

3-question sleep apnea quiz

We ask that you fill out this very brief form if you snore or are sleepy.  If appropriate, you may provide the completed form to your physician or care provider for a referral to one of our clinics.

Sleep apnea: All you ever wanted to know

A complete, in-depth description of obstructive sleep apnea, written by Dr. Clerc. Read about why and how sleep apnea occurs, why it's important to do something about it, and what can be done to treat the problem. Feel free to share this important document with your loved ones and friends.

Initial clinic questionnaire

We ask that you fill out this form PRIOR TO your evaluation in our sleep clinic.  You may either bring it with you to your appointment or mail it beforehand, as long as it reaches our clinic office by the time of your appointment.  It is detailed, but for a purpose:  we need to understand the nature of your sleep, and the questions posed will help you develop a different perspective on your own sleep.  We recommend that you ask your bed partner or family member to help fill out the form as necessary.

Transfer of sleep medicine care clinic questionnaire

If you have been evaluated in a sleep center in the past and are wanting our doctors to assume your medical care in sleep medicine, please print out this form and complete it prior to your initial clinic visit. This one-page form helps us understand what has been done regarding your previous evaluations and management, so as to make your clinic visit with us more efficient. If you have had problems with your sleep apnea treatments, for example, this document allows us to understand what problems there may have been so that we may help you as comprehensively as possible.

CPAP followup questionnaire

If CPAP (continuous positive airway pressure) has been prescribed for you, please print this questionnaire to bring with you to your clinic followup visit.  This will help your doctor determine how you are doing with CPAP use and to help solve any problems that may arise.