Do you snore loudly? Louder than talking or loud enough to be heard through closed doors
noyes

Do you often feel tired, fatigued, or sleepy during the daytime?                                
noyes

Has anyone observed you stop breathing during sleep?
noyes

Do you have (or are you being treated for) high blood pressure?
noyes

Is your BMI greater than 35 kg/m² ? BMI Calculator
noyes

Are you older than 50 years old?
noyes

Is your neck circumference greater than 16 inches (40 cm)?
noyes

Gender
femalemale

Name

E-mail

Notes