SLEEP STUDY QUALIFICATION FORM

Thank you for your interest in our sleep study at Henry Ford Sleep Center! The following online form takes about 20 minutes to complete. It allows us to gather information about your sleeping habits and your health history. Using this information, we will be able to determine whether or not you qualify for the sleep study. Please complete ALL SECTIONS of this form. After it's completed, Ryan will contact you to let you know whether or not you qualify for the study. PLEASE DO NOT USE THE BACK BUTTON ON YOUR BROWSER WHILE YOU FILL THIS OUT. It will cause errors. As always, if you have any questions, or run into any problems filling this out, please don't hesitate to contact Ryan at 313-916-2265. Thank you!