Sleep Assessment - Levata Sleep

Do you snore?

YesNo

Do you often feel tired, fatigued or sleepy during the daytime?

YesNo

Has anyone observed that you stop breathing, choke or gasp while you're sleeping?

YesNo

Do you have or are you being treated for high blood pressure?

YesNo

Is your BMI above 24 (female) or 27 (male)?

YesNo

Is your age above 50 years old?

YesNo

Is your neck size larger than 15" (female) or 16.5" (male)?

YesNo

Have you ever had a sleep test before?

YesNo

If you answered yes above, what was the approximate date of your last sleep test?

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Preferred Contact Time

MorningAfternoon

If you answered "yes" to any of the above, then you are at risk for Sleep Apnea.

If you would like to submit this Assessment, our patient liaison can reach out by phone or email to review your results and discuss next steps.

This information will help us determine if you need to get a home sleep test for Sleep Apnea.

Choose a date below to schedule a FREE 15 min PHONE call appointment. We will review your results and answer any questions you have during that call!*