Think You Have OSA?

Online Pre-Screen Tool

*all fields are required for the results to be completed and emailed to you

Complete our on-line screening tool and your results will be emailed to you, or contact us at 403-457-1127 to make an appointment to be screened at our clinic.

Name *

First

Last *

Last

Email *

Age (Years) *

Height *

(ft)

(in) *

(in)

Weight *

(lbs)

Your Sex *

Male

Female

Category 1

Do you snore? *

Your snoring is:

How often do you snore?

Has your snoring ever bothered people?

Has anyone noticed that you stop breathing during your sleep? *

Category 2

How often do you feel tired or fatigued after you sleep? *

When waking, do you feel tired, fatigued or not up to par?

Have you ever nodded off or fallen asleep while driving *

How often does this happen?

Category 3

Do you have high blood pressure? *

Note: This questionnaire was adapted from: Table 2 from Netzer, et al., 1999 (Netzer NC, Stoohs RA, Netzer CM, Clark K, Strhl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnoea syndrome. Ann Intern Med. 1999 Oct 5; 131(7): 485-91).

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LET US HELP!

After a sleep test, he quickly set up my husband with a sleep machine, and our lives have not been the same!! My hubby said good-bye to restless legs, and lack of energy, and we are both enjoying the benefits of feeling rested!

C.B.

Satisfied Customer

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