Referral Forms

Have your Primary Care Physician sign and fax the referral form to us. Once we receive the referral form and have authorization from your insurance provider, we will call you to schedule your consultation or sleep study.

• Sleep Study Referral Form

Registration Forms

If you would like to fill out your registration forms before arriving at the sleep center, you may download them here, then print, read, and complete. Please bring your forms to your scheduled appointment, to be submitted upon arrival. Please note that the forms are grouped together based on appointment types; you will only need to complete the forms which are listed below the type of appointment for which you are scheduled. Thank you.

SLEEP STUDY

• Patient Registration with Consent, HIPAA Privacy Notice, Payment Policy

• Adult Sleep History Questionnaire (Patients age 15 years and older) OR  
• Pediatric Sleep History Questionnaire (Patients age 2 years to 14 years)

• Detailed Guidelines for your Sleep Study Appointment
  (For your reference only; please consider the environment before printing this document)

Release Form

If you would like to request a copy of your sleep study report, please complete this authorization form.

• Authorization for Release of Medical Information