Let's get started.
Before we begin, we'd like a few details so we can save your progress and keep you updated throughout your sleep journey.
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Staying Connected.
We would like to send you SMS notifications regarding your appointments, care, and next steps.
Message and data rates may apply. You may opt out at any time by replying
STOP
.
Your Privacy
We'll only use this information to communicate with you about your sleep journey.
Next
Back
Next
Welcome, {name:first}.
We'd love to know how you found us.
My physician referred me
I heard your radio advertisement
Google Search
Social Media
My smartwatch or wearable device
Friend or family
Other
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Next
Great, {name:first}. Let’s talk about your sleep.
What brings you to Inhala today?
Select all that apply
I snore loudly
I wake up feeling tired or exhausted
I feel sleepy or fatigued during the day
Someone has told me I stop breathing or gasp while sleeping
My smartwatch or wearable has alerted me to a possible sleep problem
I want to sleep better and wake up feeling refreshed.
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Thanks, {name:first}. Let's talk about your sleep history.
Have you ever had a sleep study?
Yes, I have had a sleep study within the past year
Yes, I have had a sleep study, but it was more than one year ago
No, I have never had a sleep study
Next
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Great, {name:first}. Let's talk about your CPAP experience.
Many people find CPAP difficult to use. What best describes your experience?
Select all that apply
I never started using my CPAP.
I couldn’t tolerate wearing the mask.
The mask leaked or didn’t fit well.
I felt claustrophobic.
It was uncomfortable to sleep with.
I kept removing it while I was sleeping.
I still use my CPAP, but I’m looking for another option.
Other
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I don't have it with me right now. I'll provide it to my Patient Care Coordinator.
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Type a question
I’d like to use my medical insurance.
I’d prefer to pay privately (out of pocket).
I don't have my Primary insurance card with me right now. I'll provide it to my Patient Care Coordinator.
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Type a question
Yes
No
I don't have my secondary insurance card with me right now. I'll provide it to my Patient Care Coordinator.
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Cancel
of
File Upload
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