Obstructive Sleep Apnea (OSA) questionnaire

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If you answer yes to two or more of the following questions, we urge you to call us here at Emerson Dental regarding our Sleep Apnea therapy promotion to better your sleep, your health, and your quality of life.

Point scores:
0-2: Low risk of OSA
3-4: Intermediate risk of OSA
5-7: High risk of OSA

We recommend calling for a consultation if your score is between 3-7. OSA can pose a great risk to your health, worsen preexisting conditions, and has been shown to shorten one's lifespan.

Feel free to call us at 253-565-2895, email us at info@emersondentalwa.com, or submit a request at www.emersondentalwa.com

Email *

Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

1 point

Yes

Unsure

Clear selection

Do you often feel tired, fatigued, or sleepy during the day?

1 point

Yes

Clear selection

Have you ever stopped breathing during sleep, or been told that you do?

1 point

Yes

Clear selection

Do you have, or are you being treated for high blood pressure?

1 point

Yes

Clear selection

Are you over the age of 50?

1 point

Yes

Clear selection

Is your BMI higher than 30?

1 point

Yes

Unsure

Clear selection

Is your neck circumference greater than 16 inches?

1 point

Yes

Unsure

Clear selection

Would you like to be contacted by Emerson Dental to schedule a free consultation for the Solea Sleep treatment to reduce symptoms of sleep apnea? *

Yes

If you would like to be contacted regarding for a consultation, please leave your name and phone number here.

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