Patient Questionnaire / HIPPA / PHI / Photo

*Please complete all listed items on this page.*

FOR NEW PATIENTS & THOSE RETURNING AFTER 3 YEARS

Sleep Study Questionnaire

Fill Out the Questionnaire and Submit Here

HIPAA Policy

Sign and Submit HIPAA Policy Here

PHI Disclosure Form

Fill Out and Submit the PHI Disclosure Form Here


  • Please take a photo (by mobile phone) of your driver’s license and insurance cards (front and back).
  • Email all photos to info@soundasleeplab.com. On the subject line type your name and date of birth.

FOR ALL FOLLOW UP PATIENTS***

Fill out and submit Epworth Sleepiness Score here

FOR FOLLOW UP PATIENTS ( only if there are any changes)

Patient Profile Demographics

(if there are any changes in your address, phone, email, insurance, PCP etc.)

Fill Out and Submit Patient Profile Demographic Here

Fill Out and Submit the PHI Disclosure Form Here


  • Please take a photo (by mobile phone) of your insurance cards (front and back).
  • Email all photos to info@soundasleeplab.com. On the subject line type your name and date of birth.

 

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