Sleep Request Patient Intake

Step 1

Get your Sleep Score
Would never doze
Slight chance of dozing
Moderate chance of dozing
High chance of dozing
Sitting & reading
Watching TV
Sitting, inactive, in a public space (i.e a theatre or meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after lunch without alcohol
In a car, while stopped for a few minutes in a traffic
Sitting & reading
Watching TV
Sitting, inactive, in a public space (i.e a theatre or meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after lunch without alcohol
In a car, while stopped for a few minutes in a traffic
Your Sleep Score
0
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Step 2

Patient information
Please fill out all required fields
Printable PDF Request Form

Pick Your Location

Please select the office where you would like to pick up and return the Home Sleep Test device. The device must be picked up and returned to the same location.

Queen Street

(202-610 Queen Street)
Book now

8th Street

(#47-2105 Grosvenor Park Centre)
Book Now
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Printable PDF Request Form
Answer Questions in Step 1
Select the gender you currently identify as
The gender you were assigned at birth is required for testing accuracy
The physician that referred you for testing
The name of your family physician

Pick Your Location

Please select the office where you would like to pick up and return the Home Sleep Test device. The device must be picked up and returned to the same location.

Queen Street

(202-610 Queen Street)
Book now

8th Street

(#47-2105 Grosvenor Park Centre)
Book Now
Oops! Something went wrong while submitting the form.