SLEEP EVALUATION FORM

Trouble sleeping can impact your heart and your blood pressure. In an effort to promote cardiovascular health, we are committed to identifying patients with sleep disorders.

Please take a moment to answer each statement below. If you have marked "YES" next to two or more of these statements, further evaluation of your sleep patterns may be warranted. Dr. Mansoor will be happy to further discuss this with you during your appointment.

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

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