• Pre-evaluation Questionnaire

    * Level 1 Diagnostics follows HIPPA confidentiality laws and would never share any patient information. Your questionnaire will be sent directly to
    Level 1 Diagnostics.
  • MM slash DD slash YYYY
  • Cardiovascular

    Please fill out to the best of your ability and be sure and click the submit button when you are finished.
  • Sleep


  • Stop Bang

  • Snoring?
  • Tired?
  • Observed?
  • Pressure?
  • See BMI Caculator
  • Click on chart to view larger

  • Age?
  • Neck size large?
  • Pulmonary