In order to purchase the ARES Home Study Sleep Test, you must complete the assessment below. Free Sleep Apnea Assessment Please answer the following questions below to determine if you might be at risk of having Sleep Apnea. Step 1 of 4 25% Email(Required) Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required) Male Female Height(Required)Please enter a number from 3 to 7.Height(Required)Please enter a number from 0 to 12.Weight(Required)Please enter a number from 100 to 400.Neck Size(Required)Please enter a number from 1 to 30. Have you been diagnosed or treated for any of the following conditions?High blood pressure(Required) Yes No Stroke(Required) Yes No Heart disease(Required) Yes No Depression(Required) Yes No Diabetes(Required) Yes No Sleep apnea(Required) Yes No How likely are you to doze off or fall asleep in the following situations?Sitting and reading(Required) Never Sometimes Probably Definitely Watching TV(Required) Never Sometimes Probably Definitely As a passenger in a car for an hour without a break(Required) Never Sometimes Probably Definitely Sitting, inactive, in a public place(Required) Never Sometimes Probably Definitely Lying down to rest in the afternoon when circumstances permit(Required) Never Sometimes Probably Definitely Sitting and talking to someone(Required) Never Sometimes Probably Definitely Sitting quietly after lunch without alcohol(Required) Never Sometimes Probably Definitely In a car, while stopped for a few minutes in traffic(Required) Never Sometimes Probably Definitely On average in the past month, how often have you snored or been told that you snored?(Required) Never Rarely Sometimes Frequently Almost Always Do you wake up choking or gasping?(Required) Never Rarely Sometimes Frequently Almost Always Have you been told that you stop breathing in your sleep or wake up choking or gasping?(Required) Never Rarely Sometimes Frequently Almost Always
