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Snoring and Sleep Apnea Therapy LLC
Sleep apnea treatment without CPAP
224 Chimney Corner Ln Ste 3022, Jupiter, FL 33458
(561) 448-0026
Home – Sleep Apnea Treatment
Our Practice
Areas We Serve
Jupiter, Florida
Meet Dr. Burman
Mission Statement
Financial Information
Privacy Practices (PDF)
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Why Choose Us?
Sleep Disorders & Treatments
Sleep Disorders
Snoring
Insomnia
Sleep Apnea Headaches
Headaches FAQ
Daytime Tiredness
TMJ/TMD Relief
Sleep Apnea
Sleep Apnea FAQ
Treatments
Oral Appliance Therapy
NightLase®
CPAP
Testimonials
Blog
Contact
Book an Appointment
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Book Appointment
Home – Sleep Apnea Treatment
Our Practice
Areas We Serve
Jupiter, Florida
Meet Dr. Burman
Mission Statement
Financial Information
Privacy Practices (PDF)
Screener
Why Choose Us?
Sleep Disorders & Treatments
Sleep Disorders
Snoring
Insomnia
Sleep Apnea Headaches
Headaches FAQ
Daytime Tiredness
TMJ/TMD Relief
Sleep Apnea
Sleep Apnea FAQ
Treatments
Oral Appliance Therapy
NightLase®
CPAP
Testimonials
Blog
Contact
Book an Appointment
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Physician's Name
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Address
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1. Have you ever been given a CPAP device?
(Required)
Yes
No
2. If you have been given any form of CPAP, do you use it nightly?
(Required)
Yes
No
3. Are you comfortable with your CPAP and satisfied with its use?
(Required)
Yes
No
If your answer is “No” to any of the above questions, please continue to Part 1.
Part 1 Epworth Sleepiness Scale
How likely are you to doze off while doing the following activities? Please use the following scale: 0 = never, 1 = slight, 2 = moderate, 3 = high. Click one of the following numbers:
2. Sitting and talking to someone
0
1
2
3
2. Being a passenger in a motor vehicle for an hour or more
0
1
2
3
3. Sitting and reading
0
1
2
3
4. Watching TV
0
1
2
3
5. Sitting inactive in a public place
0
1
2
3
6. Lying down to rest in the afternoon
0
1
2
3
7. Sitting quietly after lunch without alcohol
0
1
2
3
8. In a car, while stopped for a few minutes in traffic
0
1
2
3
Part 2
1. Have you been told that you snore?
Yes
No
2. Does your family have a history of premature death in sleep?
Yes
No
3. Do you have diabetes?
Yes
No
4. Have you ever been told you have coronary artery disease?
Yes
No
5. Do you have high blood pressure?
Yes
No
6. Have you ever experienced irregular heart rhythms?
Yes
No
Part 3
1. Have you ever been diagnosed with sleep apnea?
Yes
No
2. Do you awaken from sleep with chest pain or shortness of breath?
Yes
No
3. Has anyone said that you seem to stop breathing while sleeping?
Yes
No
4. Is your neck size larger than 15” (female) or 16.5” (male)
Yes
No
Actual Neck Size
5. Have you ever had a stroke?
Yes
No
6. Have you ever been told you have congestive heart failure?
Yes
No
7. Do you have or did you ever have atrial fibrillation?
Yes
No
8. Are you currently taking pain meds?
Yes
No
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