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Sleep Assessment

Take our quick sleep assessment to understand your sleep health and find out how we can help you sleep better.

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Start your sleep assessment

Answer a few quick questions so we can understand your symptoms and recommend the right sleep study for you. This takes around 3 minutes.

Please bring the PDF document to your GP or physician for review and a signature before coming into one of our clinics.

if you are a GP please do sleep assessment with patient and at end sign the PDF referral. it is a requirement to do these questionnaires for a bulk billed sleep study under Medicare guidelines

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Gender*

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Address*

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(weight in kg)/Height

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Choose the sleep service you’re looking for. If you’re unsure, select what feels closest.

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Select all that apply. These symptoms help us understand what might be affecting your sleep.

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These conditions can influence the type of sleep study you may need. Please tick all that apply.

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If a GP or specialist is involved in your care, share their details below.

Doctor*
CLINIC ADDRESS
Clear Signature
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How likely are you to doze off or fall asleep in the following situations?

SITTING & READING
WATCHING TELEVISION
SITTING INACTIVE IN A PUBLIC PLACE
PASSENGER IN CAR (1 HOUR)
LYING DOWN IN THE AFTERNOON
TALKING WITH SOMEONE
AFTER LUNCH (NO ALHOCOL)
IN TRAFFIC, STOPPED BRIEFLY

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Please complete STOP-BANG Questionnaire or OSA 50 Screening Questionnaire with your patient.

Do you snore loudly?
Do you often feel tired, fatigued, or sleepy during the daytime?
Has anyone observed you stop breathing during your sleep?
Do you have or are you being treated for high blood pressure?
Are you obese/very overweight – BMI more than 35 kg/m2 ?
Age over 50 years old?
Neck circumference greater than: 43cm (male) or 41cm (female)
Are you male?

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Please complete the OSA 50 Screening Questionnaire

For males, is your waist circumference > 102cm? For females, is your waist circumference > 88cm?
Has your snoring ever bothered other people? Daytime?
Has anyone ever noticed you stop breathing during your sleep?
Are you aged 50 years or over?

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This quick check helps us confirm whether you qualify for a Medicare-supported sleep study.

Fail Medicare requirements
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