Helping  you  get  the   sleep  you  deserve

    patient form 2
    How likely are you to doze off or fall asleep in the following situations, as compared to just feeling tired? Even if you have not done some of these things recently, try to answer how you think you would be affected? Use the following scale: 0 = would never doze 1 = slight chance 2 = moderate chance 3 = high chance of dozing
    Do you snore?
    Please select“loudness” rating which best describes your SNORING
    Bed partner rating
    patient form 3

    Patient authorizes payment of insurance benefits to be paid directly to Sleep Disorders Centers or
    agrees to forward and payments issued by his Insurance for services rendered to Sleep Disorders
    Patient agrees to pay reasonable attorney fees and cost should a collection or suit be necessary to
    collect payments issued to patients by the Insurance and not forwarded to Collin County Sleep
    Diagnostics by Insured. Patient authorizes Collin County Sleep Diagnostics to release any information
    acquired in the course of the diagnostics and treatment to his physician and for collecting on unpaid