Which best describes your sleep?
*
I snore, but sleep normally otherwise
I snore and have symptoms like gasping, pauses in my breathing, or waking up tired
I struggle more with sleep quality
Do you or your partner notice that you snore?
*
Yes
No
How often do you wake up at night?
*
Rarely
Occasionally
Frequently
Almost every night
How often do you feel tired during the day?
*
Never
Rarely
Sometimes
Every day
Are you overweight, have high blood pressure, or diabetes?
*
Yes
No
Based on your responses, you may have sleep apnea and could possibly qualify for a sleep appliance.
If you do
NOT
want to wear CPAP, we just have a few more questions
to see if you qualify to wear a sleep appliance to manage your sleep apnea and snoring.
Click NEXT to get started!
Choose Your Coverage
*
Insured Through Employer
Medicare 65+
State Provided Insurance (Medicaid)
Self-Pay
Have you ever had a Sleep Study?
*
Yes, less than 12 months ago
Yes, 12 - 24 months ago
Yes, more than 24 months ago
No
Have you tried a CPAP?
*
Yes
No
Full Name
*
Email
*
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I consent to receive marketing text messages regarding services from Suburban Dental Medicine at the phone number provided, including automated messages. Message frequency varies. Message and data rates may apply. Text HELP to 847-696-8916 for assistance. Reply STOP to opt out.
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