Type
I am interested in the automatic CPAP machine that self-adjusts based on my needs
I am only interested in a basic fixed-pressure CPAP machine
Features
I am interested in a machine with a five year warranty
I am interested in a five year plan that bundles upgraded masks, filters, etc.
I am interested in your monitoring program so problems can be caught early
Timing
I am prepared to do this now or very soon
I may be ready in 3-6 months
I may be ready in 6-12 months
I may be ready in 1-2 years or more (how long? )
Weight
Since I was ,last at the sleep clinic or lab (when? ) my weight changed
I have gained weight OR I have lost weight.
Indicate how much, if known: lb or kg
Clinical
I am not currently using my CPAP very much or at all
I currently snore when I use my CPAP
Funding
I may be interested in the third-party financing program to cover my new machine
I am covered by extended health insurance that may cover me for CPAP
I can only consider a machine covered by ADP
I am interested in alternatives to CPAP
I am interested in finding out about dental appliance therapy for snoring and apnea
I am interested in seeing the Ear Nose & Throat specialist about the Pillar Procedure
I am interested in a weight loss program
I am interested in a sleep study that involves sleeping in a sleep lab; please arrange
Other information:
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