Snoring Quiz

First Name *

Last Name *

Email *

Phone *

I am a:
—Please choose an option—WomanMan

Do you snore more than three nights a week?
YesNo

Is your snoring loud (can it be heard through a door or wall)? *
YesNo

Has anyone ever told you that you briefly stop breathing or gasp when you are asleep? *
NeverOccasionally or Frequently

What is your collar size? *
Less than 16 inches16 inches or greater

Have you had high blood pressure, or are you being treated for it? *
YesNo

Do you ever doze or fall asleep during the day when you are not busy or active?
YesNo

Do you ever doze or fall asleep during the day when you are driving or stopped at a light?
YesNo

Do you ever doze or fall asleep during the day when you are not busy or active?
YesNo

Do you ever doze or fall asleep during the day when you are driving or stopped at a light?
YesNo