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Take Our Quiz




Complete Sleep Analysis is asking you to take this simple test to see if you might have a sleep disorder. Your confidential results will be emailed to us and you will receive a confirmation email. If you reply to the confirmation email we will then contact you to discuss your options.

Just check the boxes below, enter your name, address, email address and primary physician's name and click the "Submit" button. All fields in BOLD are required.

Do you or someone you love experience the following:
Snoring: YesNo

Episodes of breathing stoppage during sleep: Yes No

Gasping or snorting for air during sleep: YesNo

Excessive daytime sleepiness: YesNo

Morning headaches : YesNo

Difficulty falling asleep at night: YesNo

Difficulty waking up in the morning: YesNo

Name:


Address:


City:


State:


Zip Code:


E-mail:


Name of your primary care physician:


16601 North 40th Street, Suite 115 • Phoenix, AZ 85032
(Located in the 40th Street Medical Plaza)
Tel: (602) 682-7630 • Fax: (602) 682-7632
• TOLL FREE - (866) 348-7657


5200 E. Cortland Blvd., Suite D-6 • Flagstaff, AZ 86004
(Located at Country Club Blvd. off Interstate 40)
Tel: (928) 522-9053 • Fax: (928) 522-9076 • TOLL FREE: (866) 348-7657

4226 Avendia Cochise, #10 • Sierra Vista, AZ 85635
Tel: (520) 459-8618 • Fax: (520) 458-2865 • TOLL FREE: (866) 348-7657

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