Dr. Jennifer Silver - Cosmetic Dentistry - Making better SmilesFREE CONSULTATION

Sleep Care Test

10 times more people die in sleep related vs. alcohol related car accidents. Mental fatigue is a common sign of a bad sleep. Weight gain, aging, fatigue, heart attacks and strokes are all at higher risk with sleep disturbance issues.

Take the Sleep Disturbance Test to learn more about your lack of restful sleep. Submit your answers and we will respond shortly with our recommendations.

Do you feel you may have OSA? (Obstructive Sleep Apnea)
YesNo

Gender
MaleFemale

How often do you feel fatigued or tired after your sleep?*
AlwaysOftenSometimesNever, or nearly never

Have you ever fallen asleep or nodded off driving a vehicle?*
YesNo

Do you have any of the Following ?
DepressionHigh Blood PressureDiabetesAcid refluxGrinding and Clenching of teethPrevious Oral / Nasal surgery

I hereby attest all answers are truthful Special occasions None of the above

Dr. Jennifer Silver - Cosmetic Dentistry - Making better SmilesFREE CONSULTATION