MM slash DD slash YYYY
Name
MM slash DD slash YYYY

Why are we asking about your sleep?

Sleep Apnea

  • May increase your blood pressure
  • May increase your risk for atrial fibrillation
  • May increase your risk of stroke
  • May increase the risk of diabetes and obesity.
Do you snore loudly?
Do often feel tired or sleepy during the daytime?
Have you noticed or been told that you stop breathing or choke during sleep?
Do you have or are yo ucurrently being treated for high blood pressure?
Are you male?
Are you 50 years or older?