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MemorialCare Medical Centers, Long Beach Memorial Medical Center a hospital serving Los Angeles and Orange County
Sleep Apnea Risk Awareness Survey | MemorialCare Sleep Disorder Center | Long Beach Memorial Medical Center
Long Beach Memorial Medical Center MemorialCare Sleep Disorder Center

Sleep Apnea Risk Awareness Survey

Complete the online sleep apnea risk awareness survey below by answering Yes or No.
Sleep Apnea Risk Awareness Survey
Answer yes or no: Yes No
Do you awaken more than once at night to urinate?
Do you snore?
Does your partner tell you that you stop breathing when you sleep?
Do you wake up gasping at night?
Do you feel "worse" when you wake up?
Do you feel sleepy during the day?
Do you have high blood pressure?
Are you more than 30 pounds overweight?
Do you suffer from morning headaches?
Has your concentration, memory, or temper (irritability) been worsening?
  1. The risk assessment is not diagnostic and is not a substitute for an examination by a physician.
  2. The data derived from the risk assessment is to be considered as preliminary only, and in no way conclusive.
  3. The responsibility for any follow-up examination lies with me and not with any participating organization, employee, volunteer or individuals.
  4. I am responsible for my own health and it is my sole responsibility to follow through on any and all identified risk factors by obtaining appropriate medical attention and advice.
     
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MemorialCare Health System is a not-for-profit integrated-delivery system which includes Long Beach Memorial Medical Center, Miller Children’s Hospital Long Beach, Orange Coast Memorial Medical Center and Saddleback Memorial Medical Center in Laguna Hills and San Clemente. Our community-based hospitals are located in Southern California in both Los Angeles County and Orange County. Copyright © 1999 - 2009, Memorial Health Services. All rights reserved.