Peak Sleep Survey * 1. Do you snore while sleeping? Yes No Unsure OK * 2. Do you gasp/choke while sleeping? Yes No Unsure OK * 3. Is your neck size greater than 17 inches (male) / 16 inches (female)? Yes No Unsure OK * 4. Do you feel tired during the day? Yes No Unsure OK * 5. Do you have high blood pressure? Yes No Unsure OK * 6. Do you have morning headaches? Yes No Unsure OK * 7. Do you do shift work? Yes No Unsure OK * 8. Enter your contact information if you would like to learn more about Sleep Apnea and about our free take-home overnight test. Name Phone Email City OK DONE