Online Sleep Questionnaire Page 1
Please complete this questionnaire once you have been referred to the Sleep Clinic. The username provided by the Sleep Centre Staff will need to be entered under 'username'.
If you have any questions please contact the Sleep Centre at 403-944-2404.
** Any field that is in bold and italics are required fields!
(on the letter we mailed out. Please do not include any leading zeros). Please enter correctly as this is the only we have to identify your answers!
Home Phone (IE: 403-944-2404)
Date of Birth (Format: day/month/year)
Weight in Pounds
Height in Inches(5ft is 60, 6ft is 72)
Neck Size in Inches
Do you have a bed partner?
Do you drive?
Have you ever fallen asleep while driving?
Do you hold a Pilot's License?
If you require a translator, what language is needed?