PLEASE DO NOT COMPLETE THIS FORM.  PLEASE GO TO YOUR APPOINTMENT AND THE TECHNICIAN WILL PROVIDE YOU WITH THE FORMS YOU NEED.














To complete these forms in Spanish, click here.

Para completar estos formularios en español, haga clic aquí.

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Use the "Next Page" and "Previous Page" buttons at the bottom of each page to review or edit your submissions.



What information do I need to complete the forms?
You will need to provide information about your health insurance, current medications, current weight and height. Please have this information available before starting the forms.

If you do not wish to complete these forms online, you may complete the forms by hand when you arrive on time (please do not arrive early or late) for your scheduled appointment. Please bring a complete list of your current medications
Frequently Asked Questions:

What are these forms?

These forms are required for all patients scheduled to complete an in-center or overnight sleep study, in-home sleep test (HST) or PAP therapy (DME) set-up. 

Who has to complete these forms?
They must be completed by the patient or his/her legal guardian. If the patient is under 18 years old the forms must be completed by a parent or legal guardian. 

Do I have to complete these forms for a PAP set-up if I just completed them for a sleep study?
Yes, we require that each patient complete a full set of forms for each service. You will be asked different questions based on the type of service scheduled. We must ensure that we have your most up-to-date health, insurance and contact information. Thanks for understanding.

How do I complete these forms?
Once you start the forms, you will be directed to answer questions about your health and billing information. Many of the questions require an answer and you will not be able to complete the forms or move to the next page without answering.

You can click in each field to check a check box or type in your answer or use the TAB key to move through the fields and press the space bar to select a button. You may go back and change your responses at any time before clicking DONE at the end of the forms. Do not click refresh in your browser or you may need to start the forms from the beginning.

How long will it take me to complete these forms?
It depends on how detailed your health history is; however, most patients take about 10 minutes to complete the forms. You must complete the forms in one session as your information is not stored until the forms are completed.

What information do I need to complete the forms?
You will need to provide information about your health insurance, current medications, current weight and height. Please have this information available before starting the forms.

Do I have to complete these forms online?
No, you may print the forms and complete by hand. You may also contact us to request that we mail a copy of the forms to you. If none of these options work, you may complete the forms at the sleep center at the start of the appointment.

When should I complete these forms?
Please complete these forms before your scheduled service. Most of the forms can be completed days (or weeks) before your scheduled service; however, for some services there are forms that need to be filled out on the actual day of your service. If you are filling out the full set of forms days (or weeks) before your appointment, you may skip over these forms and fill them out at the sleep center. There will be clear instructions when you get to those forms.

What if I don't consent to the terms of service or agree with another form?
We require that all of these forms be completed (online or on paper) before we will perform your service.
Who should I contact if I have a question?
Please call us during normal business hours Monday through Friday 8am-6pm at (877) 775-3377, visit us online at www.sleepdr.com for information about our services or to chat live with a customer service representative. You can also contact us by clicking here.
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