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Important Notice and Disclaimer: This questionnaire is presented as an educational service by SleepWell America to raise public awareness on the risks associated with sleep disordered breathing. SleepWell America does not dispense individual medical advice and completing this questionnaire is not a substitute for a physical examination by a licensed physician. Though the risk score on your questionnaire may indicate the possibility of a sleep-related breathing disorder, it does not constitute a diagnosis and should not be used in place of consulting a physician. Regardless of the results of your questionnaire, the services of a physician should be sought whenever you believe you need medical advice or treatment. By continuing to the Questionnaire, you consent to submit your responses to SleepWell America. Upon receipt of your responses to this questionnaire, SleepWell America will complete a report and send it back to you along with our information kit and DVD on Sleep Awareness. These will be sent to you via U.S. mail and/or FAX or Email. In addition, SleepWell America can also submit a copy of your report to your primary care physician, provided you consent to this by filling in the necessary information on the intake form. If the results of your questionnaire indicate the possibility of a sleep-related breathing disorder, you should schedule an appointment with your primary care physician as soon as possible.
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