Sleep Questionnaire Form

Patient Information

Cinco Ranch Sleep Center uses a variety of tests to identify the cause of nighttime sleeplessness or daytime drowsiness. The majority of sleep studies must be ordered by a physician; if using insurance to cover the expense of the study then this is dependent on each individual plan. Typically, your primary care physician will order the test he or she feels is necessary.

Prior to your appointment, you will be asked to complete a questionnaire about your problems sleeping as well as your medical history. If possible, your spouse, or someone who is familiar with your sleeping patterns, should assist you in filling out the questionnaire.

Go to our short sleep questionnaire form to see if you qualify for a sleep study.

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Below is some information in preparation for your sleep study appointment:

MOST INSURANCES ACCEPTED. PLEASE CONTACT US WITH YOUR INSURANCE INFORMATION SO WE CAN VERIFY THE COVERAGE FOR YOU. YOU CAN ALSO USE OUR CONTACT FORM TO INCLUDE THIS INFORMATION SO WE CAN VERIFY. WE NEED PATIENT FULL NAME, INSURANCE NAME, MEMBER ID, AND DATE OF BIRTH FOR VERIFICATION. WE DO NOT ACCEPT MEDICARE AND MEDICAID AT THIS TIME. (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', 'UA-65071784-1', 'auto'); ga('send', 'pageview');