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enquiry/ appointment:
9007511115 / 9007566665
chamber :
03340627373
emergency:
9836747373
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our Team
VISSION, MISSION & COMMITMENT
Why Choose Us
Diagnostic Services
Multispeciality EVALUATION
Sleep study (polysomnography)
Split night study or 2 night study
Drug Induced Sleep Endoscopy
MSLT ⁄ MWT ⁄ Other Sleep disorder evolution
Treatment Services
Sleep Physician
Surgery for sleep apnea
PAP therapy
Oral appliances
Behaviour advices ⁄ sleep hygiene ⁄ Dieticien
Sleep Disorders
Sleep Apnea & Snoring
Other Sleep Disorders
Sleep Disorders In Children
Sleep Apnea & Snoring
Diagnosis & Treatment
Contact Us
1. Complete the following:
height(in meters)
age
weight (in kg)
male/female
2. Do you snore?
yes
no
don’t know
If you snore:
3. Your snoring is?
slightly louder than breathing
as loud as talking
louder than talking
very loud. Can be heard in adjacent rooms.
4. How often do you snore?
nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
never or nearly never
5. Has your snoring ever bothered other people?
yes
no
6. Has anyone noticed that you quit breathing during your sleep?
nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
never or nearly never
7. How often do you feel tired or fatigued after your sleep?
nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
never or nearly never
8. During your waketime, do you feel tired, fatigued or not up to par?
nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
never or nearly never
9. Have you ever nodded off or fallen asleep while driving a vehicle?
yes
no
If yes, how often does it occur?
nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
never or nearly never
10. Do you have high blood pressure?
yes
no
don't know
Your BMI =
Name:
Address
Email Id
Contact No
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