I, {patientName}, hereby authorize My Home Sleep Testing, LLC, it’s affiliated physicians and other medical personnel in charge of my care to administer examinations, treatments and view my prescription history from an external source and telemedicine services as needed or requested by the patient that may be deemed medically necessary in the exercise of their professional judgment. Additionally, by signing this form I attest that I will be the sole person taking the sleep test, and no other individual will wear or tamper with the testing equipment.  Furthermore, I acknowledge that I have reviewed the Terms and Conditions page at MHSleepTesting.com, which includes the Privacy Policies and Financial Responsibility Policy for My Home Sleep Testing, LLC.