Sleep Study Prescription Generator

About SleepQuest

"From my very first visit at SleepQuest, they offered friendly, prompt and professional service."Julie P.
"I traveled from Gilroy to Redwood City because of your knowledgeable staff."Geoff D.
"Before, I met with a Sleep Care Specialist, I had felt so awful for so long. Now, I feel like a new person with renewed energy and hope. I can’t thank SleepQuest enough for all their help."Christie V.
"I choose SleepQuest because their Sleep Care Specialists are always friendly, patience, and helpful."Jin T.

Expert Guide to Sleep Apnea 

This guide to understanding Obstructive Sleep Apnea (OSA) was written by SleepQuest’s Chief Scientific Officer; William C. Dement, M.D., Ph.D.

Prescriptions

Print a blank prescription or complete and print a prescription online using our new prescription generator.

Sleep Apnea Educational Videos

SleepQuest has libraries of Sleep Apnea educational videos

Take a FREE Screening

Our FREE online sleep screening can determine your pre-test likelihood of having Sleep Apnea.

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Sleep Study Prescription Generator

Complete the form below as thoroughly as possible, then click on the "Generate RX Form" button to create the prescription, you can print the page, sign and date it, and then fax it in to SleepQuest.

You must print and fax this prescription to SleepQuest when completed
Patient Information:
 
Prescribed Service(s):
 
Diagnostic Sleep Study
CPAP Titration Sleep Study
Both Studies (Performed on two separate nights)
 
Rush Order?   Yes   No
In-Home Study Justification:
 
If the patient has Blue Cross, please select a justification from the list below.
 
Patient presents with severe clinical symptoms highly suspicious for obstructive sleep apnea, and standard in-lab PSG is not readily available.
Patient is unable to be studied in a sleep lab.
Follow up to a previous sleep lab study.
Patient has a high pre-test probability of moderate to severe OSA, and all of the following are present: habitual snoring, witnessed apnea, an Epworth Sleepiness Scale score greater than 10, and obesity with a BMI >30; and who is without evidence of a significant medical comorbidity or other sleep disorders.
Additional/Custom Justification
Diagnosis(s):
 
Physician Information:
 
Additional Notes:
 
SleepQuest Location:
 
  (Leave blank if you are unsure)

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Dear SleepQuest,

Hello, my name is , I am interested in scheduling an appointment and would like more information about . Please email me or call me .

Thank you