1. Have you been told that you Snore or know that you Snore/make breathing noises while sleeping?

Yes
No

2. Do you often feel Tired, fatigued or sleepy during the day?

Yes
No

3. Has anyone Observed you stop breathing during sleep?

Yes
No

4. Do you awaken from sleep with chest pain or shortness of breath?

Yes
No

5. Do you have or have you been treated for High Blood Pressure?

Yes
No

6. Have you ever had a stroke?

Yes
No

7. Is your Body Mass Index (BMI) more than 35 lbs/inÃÃÃÃÃÂ²?

Yes
No

- Not Sure? Click here for BMI Conversion Chart

Your Weight(lbs):

Your Height(inch):

Your BMI:

8. Is your Age more than 50 years old?

Yes
No

9. Is your Gender male?

Yes
No

10. Do you have or currently wearing a CPAP?

Yes
No