Questions:
  1. I have been told that I snore?
    YesNo
  2. Is your snoring as loud as talkin
    YesNo
  3. I have been told that I stop breathing when I sleep, although I may have no recollection of this?
    YesNo
  4. I am always sleepy during the day even though I sleep throughout the night?
    YesNo
  5. Does your snoring ever bother people?
    YesNo
  6. I have high blood pressure?
    YesNo
**** (This information is confidential and will not be shared.)