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Sleep Disordered Breathing Health History Form

PART A. Obstruction Sleep Apnea & Health History

PART B. Obstruction Sleep Apnea Questionnaire:

High Risk of OSA: answering yes to two or more questions. Ask our staff for a “Sleep Apnea Survival Kit”, this kit provides education about the health concerns and treatments for snoring and sleep apnea. A low risk score does not necessarily mean you do not have sleep apnea – concerns about sleep apnea, symptoms and health consequences may always be discussed with your family physician.