Full Name
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Email Address
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Phone Number
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Where are you located?
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Select State
Alabama
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Arizona
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Florida
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Preferred city to participate in study:
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Select City
Colorado Springs, CO
Pittsburgh, PA
San Diego, CA
St. Louis, MO
Height (feet and inches)
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Weight (lbs.)
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Do you have a history of sleep apnea?
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Yes
No
If Yes, are you struggling with CPAP?
Yes
No
Are you currently using any treatment for sleep apnea?
*
Yes
No
Do you have an allergy to silicone?
*
Yes
No
Do you know your AHI ( Apnea Hypopnea Index) **optional
I give permission for a member of the SUPRA clinical trial team to contact me about more information on participating in the clinical trial.
*
Yes
No
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