• Patient Intake Questionnaire (pdf)

Please Read Questionnaire Instructions Carefully: The above Patient Intake Questionnaire should be downloaded to your computer (3.8mb) and then filled out in its entirety using Adobe Reader (you may obtain Adobe Reader using the icon link above). You can right click on the questionnaire file link above (control + click for mac) and save it that way or if you have your browser configured to open Adobe Reader for .pdf documents automatically, you can go ahead and fill out the form there and then save it to your computer afterward. However, you will then need to open the document you saved with Adobe Reader in order to send it to us. If you merely fill out the form in your web browser without saving it to your computer, the “Click to Send by Email” button at the end of the form will not work.

When you open the file you should see a pink or purple section (color appearance varies from monitor to monitor) across the top of the page. If they are not highlighted already, you may click the button at right in that pink/purple area to highlight all the fields that are to be filled in. The tab button on your keyboard will move you to each field. Otherwise, you may navigate it with your mouse. Once you have finished filling out your questionnaire, then click the “Click to Send by Email” button at the bottom of the last page (*Mac users using Preview to view .pdf documents may find that the document does not behave as described. It is recommended that you use the Adobe Reader application for best results.)

This will open a new email in your email program addressed to our sleep center with the questionnaire file you saved already attached and ready to go. You may either just add a subject and hit send or also add a note for us before the attached file if you wish.

The file is very large, so it will take some time for the email to send completely.

If you prefer, you may print the form and mail it to the address at the bottom of each page of our website.