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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).

Do you snore loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?
Do you often feel tired, fatigued, or sleepy during the daytime (such as falling asleep during driving or talking to someone)?
Has anyone observed you stop breathing or choking/gasping during your sleep?
Do you have or are being treated for high blood pressure?
Are you aged over 50?
Is your neck 'large'? (men: shirt collar 43cm or more, women: shirt collar 41cm or more)
Are you male?
What is your closest pharmacy:

Your questionnaire has been sent to your local store.

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