Quiz Results Enter information so a physician can contact you: Name: Phone: Email: Enter your zip code here to find facilities near you:

1. height  ft      inches     weight  

2. When you wake, do you often feel tired or fatigued?

No

Yes

3. During your wake time, do you often feel tired, fatigued or not up to par?

No

Yes

4. In a given week, is it common for you to fall asleep while driving?

No

Yes

5. Do you have high blood pressure?

No

Yes

6. Do you have a history of heart disease or stroke?

No

Yes

7. Do you snore:

No

Yes

Not Sure