Home Sleep Apnea Test – Intake Form Complete HSAT Intake Form Results This field is hidden when viewing the formTestPassThank you for completing the questionnaire, we will contact you shortly to book a phone sleep assessment in preparation for your FREE at-home sleep test. To contact us and book now, reach out to your dream team at:Based on your questionnaire results, you may require a different form of sleep testing. Snore MD will send a letter to your referring practitioner at this time. We will contact you if your referring practitioner advises Snore MD to proceed with a home sleep test. Otherwise, please follow up with your practitioner. FREQUENTLY ASKED QUESTIONS Why may I require a different form of testing? You may be at a low risk for Obstructive Sleep Apnea or a Home Sleep Test may not be the best option for testing your sleep quality at this time. You will need to follow up directly with the practitioner or Doctor who referred you, who may suggest a different type of Sleep Test. Your practitioner or doctor may also re-refer you to Snore MD to proceed with the Home Sleep test, and we will contact you if so. What should I do next? You should make an appointment with your referring practitioner or doctor to discuss the next steps. They may want you to complete the Home Sleep Test by re-referring you to Snore MD, or refer you for a different type of Sleep Test. If you have any questions please contact:Based on the results of the intake form, you may require a different form of sleep testing. At this time, we suggest you reach out directly to your Family Doctor or Healthcare practitioner for further investigation. If you have any questions do not hesitate to email us at:This field is hidden when viewing the formClinics BELOW 778-621-2011 778-621-2011 [email protected] 778.619.2002 778.619.2002 [email protected] 236-437-2001 236-437-2001 [email protected] 778-721-5810 778-721-5810 [email protected] 778-771-0169 778-771-0169 [email protected] 778-621-2162 778-621-2162 [email protected] 778-624-2004 778-624-2004 [email protected] 778-620-2235 778-620-2235 [email protected] 778-488-5346 778-488-5346 [email protected] 604-900-9497 604-900-9497 [email protected] 778-764-1758 778-764-1758 [email protected] 604-670-9990 604-670-9990 [email protected] 778-754-7595 778-754-7595 [email protected] 778-362-1717 778-362-1717 [email protected] 604-481-0164 604-481-0164 [email protected] 250-853-2211 250-853-2211 [email protected] 236-454-6450 236-454-6450 [email protected] 250-419-7475 250-419-7475 [email protected] 587-787-3013 587-787-3013 [email protected] 833-766-7363 [email protected]This field is hidden when viewing the formClinics AboveTo make your appointment more efficient, please provide us with the following information:This field is hidden when viewing the formPrimary InsuranceAlberta Blue CrossCanada LifeCanwestChamber of CommerceClaimsecureCo-OperatorsCoughlinD.A Townley Insurance ProcessDesjardinsDoesn't KnowEmpire LifeEquitable LifeFirst Nations Health Authority (FNHA/NIHB)GreenshieldGroupsourceIndustrial AllianceManitoba Blue CrossManulife Affinity (Individual Plans #1777F)Manulife Group BenefitsMaximumMedavie Blue CrossMinistryMy Group HealthNone (Patient Has No Insurance)Olympia BenefitsOtherPacific Blue CrossParole Board (For Parolees with Equipment)Refuse to GiveRWAMSimply BenefitsSSQ (Part of Provider Connect)SunlifeTeamstersWaterfront Employers of BCThis field is hidden when viewing the formPersonal Health Number Δ
