How Can We Help You?

By evaluating your sleep patterns in our safe, comfortable and homelike environment, we are able to collect incredibly valuable data and make recommendations, or suggest treatments, that will improve the quality of your sleep, energy levels and
overall well-being.

Pre-Study Questionaire

Fill out prior to your arrival

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HST Questionaire

Complete prior to your Home Study

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HST Questionaire

HST Questionaire

Completely Fill in One Circle for Each Question – Answer ALL Questions
Have you been diagnosed or treated for any of the following conditions?

Epworth Sleepiness Scale:

How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to mark the most appropriate box for each situation.

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

PATIENT PRE-STUDY QUESTIONNAIRE

PATIENT PRE-STUDY QUESTIONNAIRE

Sleep History – Nighttime
from AM/PM until AM/PM
On workdays
When I am not working
Please check all of the following that ever apply to you at night:
This part to be filled out by someone who has observed you sleep
Sleep History – Day Time
Past Medical History
(Check all that apply and/or fill in the blanks)
Please list all current medications including non-prescription medications (attach list if necessary):
Please list all current medications including non-prescription medications (attach list if necessary):

Our Location

Sleep Health Solutions
267 Portage Trail Extension
West Suite 100,
Cuyahoga Falls, OH 44223
Phone: (330) 923.0228
Fax: (330) 923-1020

Hours

Monday through Friday: 9:00 AM – 5:00 PM
Saturday and Sunday: By appointment only

Directions

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Please fill out the fields below and one of our specialists will contact you shortly. Want to speak to us now? Call us at (330) 923.0228.

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