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Please Complete All Sections in Full, this should be filled by doctors

  • Male Female

  • SERVICES REQUESTED FOR:

  • SLEEP STUDY AND CONSULT
  • SLEEP STUDY ONLY
  • CONSULT ONLY CPAP FOLLOW UP

          (Consult Advisable)
  •   Has this patient had a sleep study done previously?   No   Unknown   Yes, study was done on

  • REASON FOR REFERRAL

  • Snoring
  • Non-Restorative Sleep
  • Fibromyalgia
  • Witnessed Apnea
  • Hypersomnolence/fatigue
  • Narcolepsy / Sleepiness
  • Insomnia
  • Morning Headache
  • CPAP follow up
  • Parasomnia
  • Nocturnal Seizures
  • Post Surgery
  • Oral Appliance
  • MSLT/MWT
  • Periodic Legs Movements/Restless Legs
  • Others:

  • PAST MEDICAL HISTORY:

  • Other Health Related Problems:
  • Current Medications:
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About Us

Our physicians are highly skilled and widely experienced in the field of sleep medicine. We commit ourselves to providing clinical, educational and technical excellence, respect, integrity and compassion to those persons who entrust us with their sleep health.

Medical Guide

Opening Hours

  • Monday to Friday
  • 9 am - 8 pm
  • Saturday
  • 9 am - 1 pm

Address

106 Humber College Blvd. Suite 202 Etobicoke, ON M9V 4E4

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