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Considering a sleep study?
Hi there, please fill out and submit this form and include health information for either yourself or your patient.
13
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1
Medical Disclaimer & Terms of Use
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Please read and agree to the following terms before taking the quiz: 1. Educational & Informational Purposes Only The "Do I Need a Sleep Study?" self-assessment tool at juliawhitaker.com is designed solely for educational, informational, and self-screening purposes. The results, pathways, and recommendations generated by this quiz are not medical advice, medical diagnoses, or formal treatment plans. 2. No Doctor-Patient Relationship Created Completing this quiz or reviewing its results does not establish a doctor-patient relationship between you and Dr. Julia Whitaker, Rise Precision Medicine, or any associated clinical staff. 3. Not a Replacement for Clinical Evaluation This quiz is not a substitute for professional medical care, diagnosis, or treatment. Sleep disorders are complex, and an accurate assessment requires a direct evaluation by a qualified healthcare professional who can review your full medical history, physical health, and specific clinical symptoms. 4. Emergency & Urgent Symptoms If you are experiencing a medical emergency, severe shortness of breath, unexplained chest pain, or uncontrollable daytime sleepiness that puts your safety at risk (such as falling asleep while driving), do not rely on this quiz. Call 911 or seek immediate emergency medical attention. 5. Acknowledgment & Consent By clicking "I Agree" and proceeding to the quiz, you acknowledge that you have read, understood, and agreed to this disclaimer. You understand that any actions you take based on the results of this quiz are at your own discretion, and you should always consult a licensed healthcare provider regarding any questions or concerns about your health.
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2
Sex at Birth
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Male
Female
Intersex
Prefer not to say
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3
Age
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4
Are you pregnant?
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YES
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5
BMI
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<18.5 Underweight
18.6-24.9 Healthy Weight
25.0-29.9 Overweight
30.0+ Obese
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6
Pre-pregnancy BMI
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<18.5 Underweight
18.6-24.9 Healthy Weight
25.0-29.9 Overweight
30.0+ Obese
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7
What is driving your interest in getting a sleep study?
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I want to verify whether current sleep therapy for sleep apnea is working and effective
I am using CPAP but continue to have relevant symptoms
I am using an oral appliance but continue to have relevant symptoms
I am using Inspire but continue to have relevant symptoms
I have relevant symptoms
I have health concerns that could be addressed with sleep therapy
I want to confirm or rule out sleep disorder
I want to confirm or rule out Periodic Limb Movement Disorder (PLMD)
I had an at home test that was negative for sleep disorder but I still have concerning symptoms
I'm curious about sleep apnea
I want to know if I'm getting enough deep sleep and see what my sleep cycles (light, deep, REM) look like?
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8
Symptom Checker
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Loud snoring
Witnessed breathing pauses during sleep
Falling asleep uncontrollably during the day
Unexplained excessive daytime sleepiness
Unexplained fatigue
Unrefreshing sleep
Poor sleep quality
Severe insomnia
Waking up frequently
Waking 2 or more times a night to urinate
Morning headaches
Nighttime reflux or heartburn
Neuromuscular weakness
Cognitive concerns
Mood swings
None of these
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9
Have you been diagnosed with a sleep disorder such as sleep apnea?
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YES
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10
What form of treatment are you receiving?
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Active CPAP user
Inspire device user
Oxygen
Oral Appliance user
None of these
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11
Have you been diagnosed or do you have a history of any of the following medical conditions
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Hypertension
Diabetes
Narcolepsy
Parasomnia
Family history of Alzheimer's disease or dementia
None of these
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12
Have you been prescribed 3 or more antihypertensive medications to take at one time?
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13
Do you have albuminuria?
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YES
NO
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14
Do you regularly have blood glucose over 180mg/dL despite taking your medications or insulin?
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YES
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15
Do you have a history of any of the following medical conditions
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Heart failure
Atrial fibrillation
Peripheral arterial disease
Scleroderma
Raynaud’s phenomenon
Stroke
None of these
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16
Are you taking any of the following medications?
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Nitroglycerin: Nitrostat, Nitroquick, Nitrolingual, NitroMist, GoNitro
Isosorbide Dinitrate: Isordil
Amyl Nitrite Inhalant: Generic Amyl Nitrite
Doxazosin: Cardura
Prazosin: Minipress
Terazosin: Hytrin
Tamsulosin: Flomax
Alfuzosin: Uroxatral
Silodosin: Rapaflo
None of these
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17
Do you smoke or vape?
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YES
NO
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18
Do you use opioids?
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YES
NO
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19
Have you been prescribed Oxygen during the day or at night?
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YES
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20
Would you like to receive a printable resource to use with your next patient or at your next physician visit? We will email a tool that helps doctors facilitate the conversation about sleep studies and evaluate the variables to help decide the best diagnostic tool for their patients. If you are a patient, this tool helps you communicate the critical points to your doctor and advocate for your sleep study needs.
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21
Are you a patient or a physician?
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Patient
Physician
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22
Name
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First Name
Last Name
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23
Email
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example@example.com
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