Patient Information
Patient Information
Telesleep
Telesleep
Corporate Wellness
Corporate Wellness
Sleep & Neuroscience Associates
Sleep & Neuroscience Associates
Pin
15 Valley Drive, Suite 3E, Greenwich, CT 06831
203-653-3519
info@sleepwellMD.com
Home
About
Why Get Treated?
In the News
Sleep Disorders
Sleep Apnea
Narcolepsy
Insomnia
Restless Legs Syndrome
Parasomnias & RBD
Pediatric Sleep Disorders
Circadian Rhythm Disorders
Treatments
CPAP & CPAP Alternatives
Medical Management of Sleep Disorders
Cognitive Behavioral Therapy for Insomnia (CBTi)
Services
Sleep Study
Telesleep
DOT Evaluations
Corporate Wellness Programs
Improve Your Sleep (Sleep Devices)
Pre-Operative Sleep Apnea Screening
Patient Information
Insurance
Patient Forms
Snore Quiz
Epworth Scale
Blog
Contact Us
Snore Quiz
Take Our Snore Quiz
Do you have sleep apnea?
Take our snore quiz to find out how severe your snoring problem is and to determine whether you are at risk for sleep apnea.
Step 1 of 3
33%
I am a:
*
Woman
Man
Do you snore more than three nights a week?
*
Yes
No
Is your snoring loud (can it be heard through a door or wall)?
*
Yes
No
Has anyone ever told you that you briefly stop breathing or gasp when you are asleep?
*
Never
Occasionally or Frequently
What is your collar size?
*
Less than 17 inches
17 inches or greater
What is your collar size?
*
Less than 16 inches
16 inches or greater
Have you had high blood pressure, or are you being treated for it?
*
Yes
No
Do you ever doze or fall asleep during the day when you are not busy or active?
*
Yes
No
Do you ever doze or fall asleep during the day when you are driving or stopped at a light?
*
Yes
No
Request an Appointment
First Name*
*
Last Name*
*
Email*
*
Phone*
*
Type of Appointment*
*
Type of Appointment*
In Office Appointment
Telesleep Appointment
Corporate Wellness Program Appointment
Comments
CAPTCHA
Areas of Specialty
Sleep Apnea
Plus
Narcolepsy
Plus
Insomnia
Plus
Restless Legs Syndrome
Plus
Parasomnias
Plus
Pediatric Sleep Disorders
Plus
Circadian Rhythm Disorders
Plus
CPAP & CPAP Alternatives
Plus
Location
Our Location
Pin
15 Valley Drive, Suite 3E, Greenwich, CT 06831
203-653-3519
info@sleepwellMD.com
Get Directions
Thank you! We will get back to you as soon as possible.
Request an Appointment
Type of Appointment*
In Office Appointment
Telesleep Appointment
Corporate Wellness Program Appointment