SNORING

SNORING

Do you snore? *

You snoring is: *

How often do you snore? *

Has your snoring ever bothered other people? *

Has anyone noticed that you stop breathing during your sleep? *

FATIGUE

FATIGUE

During your waking time, do you feel tired, fatigued or not up to par? *

How often does this occur? *

Have you ever nodded off or fallen asleep while driving a vehicle? *

How often does this occur? *

RISK FACTORS

RISK FACTORS

Do you have high blood pressure? *