Step 1: Adult Initial Contact Form

Adult Home Sleep Study

Please fill in these quick questions so we can find out more about you and what type of sleep study service you need. Submit your details and Aer's friendly staff will contact you or you can get started straight away. Don't worry if you get lost, we will contact you if we see that you need help.
Name

First NameLast Name
Mobile Phone Number
Please enter a valid mobile phone number so we can remind you when your sleep study is coming and when you have to return it.Format: 0000000000.
Email
If this email is not correct, you will not receive the report
Date of birth

DayMonthYear
Date
How did you find out about our service? You can choose more than one option
Please provide further details about your dentist, so we can keep them informed of your progress
Dentist's name:
Dental clinic's name:
Dental clinic's email address:
If this email is not correct, your dentist will not receive the report
Please provide further details about your orthodontist or specialist dentist, so we can keep them informed of your progress
Orthodontist or specialist dentist's name:
Orthodontist or specialist clinic's name:
Orthodontist or specialist clinic's email address:
If this email is not correct, your orthodontist will not receive the report
Please provide further details about your GP or specialist medical doctor, so we can keep them informed of your progress
GP or specialist medical doctor's name:
GP or specialist medical clinic's name:
GP or specialist medical clinic's email address:
If this email is not correct, your GP will not receive the report
Please upload a photo or pdf of your referral here

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Please provide further details of the professional that recomended you to us, so we can keep them informed of your progress
Professional's name:
Professional clinic's name:
Professional clinic's email address:
If this email is not correct, your recommending professional will not receive the report
Do you have a Medicare card?
Does your Medicare card say 'Reciprocal Health Care'?
Please note: Only visa holders from countries with a Reciprocal Health Care Agreement have this card (your Medicare card will say "Reciprocal Health Care" or "RHCA" on it).

Reciprocal cardholders are NOT eligible for a Medicare claim for this sleep study — you would need to pay privately if you proceed with a booking.

Example Reciprocal Health Care Medicare card:
Have you had a home sleep study in the last 12 months?
Would you like to receive a copy of your sleep study report?
Please note: When you submit this form, we'll take you to our booking page where you can choose a date for your home sleep study and pay the booking fee.

After you've booked, you'll fill in a short medical history form so we can confirm your Medicare eligibility for the sleep study.

If it turns out you're not eligible and you'd prefer not to continue with a self-funded sleep study, we'll refund your booking fee in full.
Please note: When you submit this form, we'll take you to our booking page where you can choose a date for your home sleep study and pay the booking fee.

After you've booked, you'll fill in a short medical history form so we have all the required details to prepare and send your kit.
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Adult Home Sleep Study