Patient Sleep Test

Do you need a sleep study?

Please complete the following survey to determine if you could be eligible for a bulk billed sleep study. You can take the survey results to your doctor and request a referral to NBST for highly experienced care.

Sleep Study Survey

The results will be emailed to the supplied email address. Discuss the results with your doctor and request a referral to NBST.

Do you snore loudly (louder than talking or heard through closed doors)?(Required)
Do you often feel tired, fatigued, or sleepy during daytime?(Required)
Has anyone observed you stop breathing during your sleep?(Required)
Do you have or are you being treated for high blood pressure?(Required)
Age over 50 years old?(Required)
BMI more than 35kg/m2?(Required)
Neck circumference less than 40cm (16 inches)?(Required)
Gender(Required)
Sitting & reading(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
Watching TV(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
Passenger in a car trip greater than 1 hour(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
Sitting and talking to someone(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
Sitting inactive in public (meeting or theatre)(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
Lying down to rest in the afternoon when circumstances permit(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
Sitting after lunch without alcohol(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
In a car stopping in traffic for a few minutes(Required)
Indicate the chance of dozing: 0 - Unlikely; 1 - Slight; 2 - Moderate; 3 - Highly likely
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Name(Required)

Contact us to book an appointment

Visit us at either our Clayfield or North Lakes location and experience compassionate care in a comfortable environment, tailored to meet your unique needs.

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