OSA ONLINE ASSESSMENT

Full Name*

First NameLast Name

Date of Birth*

Date

What is your gender?*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Email Address*

example@example.com

Is it possible that you have Obstructive Sleep Apnea (OSA)?

Please answer the following questions below to determine if you might be at risk.

YesNo

Height (in inches)

Weight (in pounds)

Body Mass Index Calculator

Enter your height and weight above to calculate your BMI

YesNo

OSA Score

OSA - Low Risk : Yes to 0 - 2 questions
OSA - Intermediate Risk : Yes to 3 - 4 questions
OSA - High Risk : Yes to 5 - 8 questions

We are pleased to inform you that based on your answers you are at low risk for the presence of Obstructive Sleep Apnea (OSA) and that you are at a lower likelihood of experiencing significant breathing disturbances during sleep.

It is important to maintain healthy sleep habits and seek medical attention if you experience any changes in sleep patterns including disruptive snoring or any other symptoms suggestive of sleep disorders in the future.

If you have any questions or concerns or would like further guidance on maintaining optimal sleep health, please feel free to schedule a visit with a Sleep Specialist at BlueSleep.

We are here to support you in achieving restful and rejuvenating sleep.

Your answers indicate a moderate risk for the presence of Obstructive Sleep Apnea (OSA), which means you might be experiencing breathing interruptions during sleep and further evaluation and management are necessary.

The good news? This is a treatable condition! Eastern Dental partners at BlueSleep can provide a more detailed evaluation and recommend the best course of action for a restful night's sleep. We're here to help!

If you have any questions or concerns or would like to schedule a consultation with a sleep medicine specialist, please click here to schedule a consultation. We are here to support you on your journey to better sleep and overall well-being.

We regret to inform you that your recent screening results indicate a high risk for the presence of Obstructive Sleep Apnea (OSA). Your test outcomes suggest a significant likelihood of experiencing breathing disturbances during sleep.

It is important to seek further evaluation by a healthcare provider specializing in sleep medicine to confirm the diagnosis and initiate appropriate treatment interventions.

If you have any questions or concerns regarding your results or would like to schedule a consultation with a sleep medicine specialist, please do not hesitate to contact our office. We are here to support you in addressing your sleep health concerns and improving your overall well-being.

YesNo

Obstructive Sleep Apnea (OSA) Assessment

OSA Screening