How long have you had your CPAP?
Less than a year
1-2 years
2 or more years
Do you dream?
Yes
No
Unsure
When was your last sleep test?
Less than a year ago
More than a year ago
How would you describe your sleep?
Insufficient - Always Tired
Very Restful
Restless / Tossing & Turning
Do you use your CPAP?
Yes, I use it every night
Yes, but I rarely use it
No, I never use it
(Select all answers that apply)
What don't you like about your CPAP?
Too much pressure
Feel claustrophobic
Mask is uncomfortable and leaves marks
Feel like I can't breathe
Too noisy
Generally uncomfortable
Hard to clean
How Did You Hear About Us?
Full Name
Phone
*
Email
*
Date of birth
Gender / Pronouns
Weight (In Pounds)