Self Referral

Our self-referral below is the quickest way to book your appointment if you are booking without a physician. Complete the form below and we will call you within two business days.

Please note: We require 2 business days’ notice to cancel or reschedule any appointments. Late cancellations and no-shows will be subject to a fee of $200.

Self Referral Form
Sex *
Primary Sleep Concerns *
Are You Looking For a Sleep Study? *
Do you currently use a CPAP machine or a dental appliance for sleep apnea (excluding night guards for teeth grinding)? *
Please choose Yes or No. All questions are required.
Have you been told that you snore loudly or that you stop breathing during sleep? *
Do you sometimes wake up with a headache? *
Do you experience unusual movements or behaviors during sleep, such as kicking, jerking, or sleepwalking? *
Have you ever fallen asleep unexpectedly during the day (e.g., while working, driving, or talking)? *
Do you experience restless or uncomfortable sensations in your legs at night that make it difficult to sleep? *
Do you have a history of lung or heart disease? *
Would you require a sleeping aid for the sleep study? *
Additional Information
How Did You Hear About Us?
Safety Sensitive Occupation (If Applicable)

Physician Referral

If you are a practicing physician looking to refer a patient, please visit our physician referral page.