Pediatric Referral Form
Please complete and submit this form, and the Institute's Sleep Care Specialist will contact the patient to schedule tests that you have ordered. Items in bold (patient name, physician name and physician telephone) are required.

To download the Pediatric Referral Form, a printable pdf, click here


Adult Referral Form
Please complete and submit this form, and the Institute's Sleep Care Specialist will contact the patient to schedule tests that you have ordered. Items in bold (patient name, physician name and physician telephone) are required.

To download the Adult Referral Form, a printable pdf, click here

Sleep Disorders Inventory
Take our Sleep Disorders Inventory©, an extensive survey that will help you and your patient to evaluate and treat your sleep complaint. You may also ask to submit your survey to the Sleep Disorders Institute for review.

To download the Sleep Disorders Inventory©, a printable pdf, click here

Sleep Log
Use a Sleep Log to record your sleeping schedule over the course of 2 weeks. The Sleep Log may help you to diagnose the nature of any sleeping problem your patient might have.

To download our Sleep Log, a printable pdf, click here

Epworth Sleepiness Scale
Use the ESS to evaluate a patient’s level of sleepiness. By asking the patient to rate the probability of falling asleep in different scenarios on a scale of 0 – 3; 0 being you would never doze off and 3 being high chances of you dozing off, you can effectively measure the levels of excess sleepiness.

To download the Epworth Sleepiness Scale, a printable pdf, click here

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