BED PARTNER SURVEY

Is Your BED PARTNER Keeping You Up At Night?

BED PARTNER SURVEY

Is Your BED PARTNER Keeping You Up At Night?

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Silverdale, WA
(360) 979-1537
(360) 779-7732
10513 Silverdale Way NW Suite 201
Silverdale, WA 98383
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Federal Way, WA
(253) 352-4430
(866) 861-6286
32114 1st Ave S Suite 104
Federal Way, WA 98003
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Bellevue, WA
(425) 428-6829
(425) 746-0146
1380 112th Ave NE, Suite 307
Bellevue, WA 98004
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Bed Partner Survey

Are you concerned that your bed partner may have some sort of sleep condition that could be detrimental to their overall health? Fill out this survey about your bed partner’s sleeping habits, and we will contact you as soon as possible if we feel we can help in any way.

Do you witness the patient snoring?(Required)
Do you witness the patient choking or gasping for breath during sleep?(Required)
Does the patient pause or stop breathing during sleep?(Required)
Does the patient fall asleep easily, if given the opportunity, during the day (normal wakeful hours)?(Required)
Do you witness the patient clenching and/or grinding his/her teeth during sleep?(Required)
Does the patient still appear tired upon awakening from a normal night’s sleep?(Required)
Do the patient’s sleep habits disturb your sleep?(Required)
Does the patient sit up in bed, not awake?(Required)
Please check those sleep habits of the patient that are disturbing to you:

The more “Yes” answers given, the more likely it is that your bed partner has the life-threatening condition called sleep apnea. If you answered more than 2 or 3 questions with a “yes”, your bed partner should be evaluated for sleep apnea as soon as possible. Complete this form to contact us now to find out how we can help!
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