Submitted by ahs-admin on Thu, 11/28/2019 - 14:44 You must have JavaScript enabled to use this form. 1 Start 2 Complete Are you often sleepy during the day? Yes No Do you doze off during quiet activities, such as reading or watching TV? Yes No Have you been told that you snore excessively? Yes No Do you have a weight problem? Yes No Do you wake up in the morning with headaches? Yes No Do you recall awaking at night gasping for air? Yes No Does your heart beat irregularly at night? Yes No Do you frequently awaken without feeling refreshed? Yes No Do you find yourself dozing off while driving? Yes No Does lack of energy affect your work or family life? Yes No Full Name * Email * Phone Leave this field blank Submit
