Sleep Test Appointment Request

Kindly fill up your details below, and answer a simple questionnaire on the next page.

Collection and return of Sleep Test Kit is at BMEC Sleep Care office. If collection is on Tuesday, kindly return the sleep test kit on Thursday. If collection is on Friday, kindly return the sleep test kit on Monday.

STOP-BANG QUESTIONNAIRE

Please answer all the questions below:

Measured around Adams apple. Is your shirt collar 16 inches / 40cm or larger?

Please Note

We will need to use some of your personal information in order for us to set up the sleep test device, diagnosis of your sleep, and recommendation of treatment (if any). By filling up this online form and agreeing to do this sleep test, we will take it that you have acknowledge and allow us to use your personal information for the purposes mentioned above.