114 W Columbia St. Ste B,
Weatherford, TX 76086
(817) 594-3806 Find Out if You Have Sleep Apnea »
Find Out if You Have Sleep Apnea »

Take Our Sleep Apnea Quiz

Before you arrange a visit at our Weatherford, TX location, it’s important for Dr. Deborah Romack and her team to understand the likelihood of sleep apnea in your case. If snoring is a regular part of your nighttime routine, please fill out the following questionnaire to the best of your ability. The number of “yes” responses you give influences our understanding of your condition. Within 24 hours of submitting the form, you’ll hear from a member of our team about the results and whether or not we would recommend a consultation visit.

Yes
No

Snoring

Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Yes
No

Tired

Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Yes
No

Observed

Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

Yes
No

Pressure

Do you have or are being treated for High Blood Pressure?

Yes
No

Body Mass Index more than 35 kg/m2?

Not sure what your BMI is? Click here

Yes
No

Age older than 50?

Yes
No

Neck size large? (Measured around Adams apple)

For male, is your shirt collar 17 inches / 43 cm or larger? For female, is your shirt collar 16 inches / 41 cm or larger?

Yes
No

Gender = Male?

Property of University Health Network.

If you would like our interpretation of your STOP-BANG Questionnaire, please send us the information below. Dr. Romack will be in touch within 24 hours to discuss your results.

114 W Columbia St., Weatherford, TX 76086 USA
Deborah A. Romack, DDS Weatherford, TX dentist providing sleep apnea therapy. (817) 594-3806 cafd11@sbcglobal.net