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?
PLEASE READ RELEASE FORM: By clicking submit you are agreeing to: I hereby release Long Beach Memorial Medical Center and other organizations associated with this sleep apnea risk assessment, parent company and all other employees and volunteers and any other individuals associated with the risk assessment or from any information provided at this website, from any and all liability which may arise. I understand: The risk assessment is not diagnostic and is not a substitute for an examination by a physician. The data derived from the risk assessment is to be considered as preliminary only, and in no way conclusive. The responsibility for any follow-up examination lies with me and not with any participating organization, employee, volunteer or individuals. 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.