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STOP-BANG Quiz

To determine risk level for Obstructive Sleep Apnoea (OSA)

Please complete this form and submit it prior to your initial sleep apnoea consultation at either Fullife Pharmacy Mill Park (VIC) or Ulverstone (TAS).

First name*

Last name*

Email*

Phone

What is your closest store?*

Do you snore loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?*

Yes

No

Do you often feel tired, fatigued, or sleepy during the daytime (such as falling asleep during driving or talking to someone)?*

Yes

No

Has anyone observed you stop breathing or choking/gasping during your sleep?*

Yes

No

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

Yes

No

Are you aged over 50?*

Yes

No

Is your neck considered 'large'?*

Yes

No

Large measurements:

Men: shirt collar 43cm or more; Women: shirt collar 41cm or more

Are you male?*

Yes

No

What's your BMI?*

Click here for a BMI calculator

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