Sleep Quiz - CPAP and Sleep Disorder Clinic PH

Think You Have OSA?

Where did you find us?*
Your Name*
Contact Number*
Email*
Age*
Height*
ft in
Weight*
Gender*
- Male
- Female
Do you snore? **
- Yes
- No
- Don't know
Has anyone noticed that you stop breathing during your sleep?*
- Nearly Everyday
- 3/4 Times / Week
- 1/2 Times / Week
- 1/2 Times / Month
- Never or Nearly Never
How often do you feel tired or fatigued after you sleep?*
- Nearly Everyday
- 3/4 Times / Week
- 1/2 Times / Week
- 1/2 Times / Month
- Never or Nearly Never
Have you ever nodded off or fallen asleep while driving?*
- Yes
- No
- Don't know
Do you have high blood pressure?*
- Yes
- No
- Don't know

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