Sleep Apnea Self-Evaluation

Print this form now if you want to complete the form manually and bring it to your appointment.

You may also type in your answers and then print the form for your records at the bottom.


If you checked nine or more of the boxes above, there is an 80% chance that you have Sleep Apnea. Please answer the questions below.

To print this self-evaluation for your own records, YOU MUST PRINT IT BEFORE YOU CLICK "SEND".

You should see a medical doctor to arrange a sleep study. Once completed, if you do, in fact, have sleep apnea, the doctor may recommend a CPAP machine for treatment. However, if you find that you just cannot adjust to the CPAP machine, revisit our website to learn about a simple dental device that treats Sleep Apnea. In fact, 80% of those who cannot tolerate a CPAP machine do very well when using a dental device instead.

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  • Curtis Group
  • 9402 November Dr
  • St. Joseph, MN 56374
  • Phone: 1-320-363-0210
  • Fax: 1-320-363-0218
  • Email: Email Curtis Group