Would you like Dr. Roubal’s team to follow up with you about your results? Yes, I would like Dr. Roubal's team to follow up with me Name* First Last Phone*Email* Snoring*Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?Choose OneYesNoTired*Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?Choose OneYesNoObserved*Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?Choose OneYesNoPressure*Do you have or are being treated for High Blood Pressure?Choose OneYesNoBody Mass Index more than 35 kg/m2?*Not sure what your BMI is? Click HereChoose OneYesNoAge older than 50?*Choose OneYesNoNeck size large? (Measured around Adams apple)*For male, is your shirt collar 17 inches / 43 cm or larger? For female, is your shirt collar 16 inches / 41 cm or larger?Choose OneYesNoGender = Male?*Choose OneYesNoCountEmailThis field is for validation purposes and should be left unchanged.