Sleep Survey

Did you know snoring and how you breathe in your sleep can lead to serious health issues?

Please answer the following questions. It only takes a couple minutes! After you submit your answers one of our team members will reach out to you for a one on one consultation with Dr. Randy Shoup.

Full Name *
Email *
Phone *
How many times a night do you get up to go to the bathroom? *
How often do you dream? *
Who tells you that you snore? *
Has anyone ever said you stop breathing when you snore? *
Have you awakened yourself either snoring or gasping for air? *
How often do you get drowsy when driving in your car? *
Have you been diagnosed with high blood pressure? *
If so, do you take medication for HBP?
Would you like to lose weight? *
If so, how much?
Is your neck size over 18 inches? *

Verification

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