Sleep Study Order Form
Sleep Healers offers a patient screening tool and order form called the “Dreams Form” which helps identify patients that may have a sleep disorder. Signs and Symptoms of common sleep disorders are listed. The signed form provides authorization for your patient to be evaluated and treated for sleep disorders at a Sleep Healers Facility. Please include patient demographics and or insurance information when submitting the form.
Fax Number: 972-831-8015 Main Number: 972-506-7800
Dreams Form
The Dreams Form is a short questionnaire intended to help patients recognize the symptoms of a possible sleep disorder. This helps in diagnosing their sleep disorders. Sleep Healers wants patients to share their results with you so they can learn what goes on when the lights go out and how to get "The Best Rest of Their Life!"
Our standard Sleep Study Order Form provides authorization for testing for sleep disorders at a Sleep Healers Facility.
- Evaluate and Treat order: Includes a Diagnostic Polysomnogram and 2nd night CPAP titration if needed
- Polysomnogram (PSG): 1st Night Diagnostic Study for evaluation only
- Post Surgical PSG Study: Study completed as follow up to ENT surgery for OSA/snoring
- CPAP/BIPAP Titration Study: 2nd night Titration following Diagnostic Study with DX of OSA
- Split Night Study: Initial Diagnostic period followed by CPAP initiation for RDI >40
- MSLT: Daytime Nap Study for EDS (PSG performed the preceding night)
- Consultation with Sleep Specialist: Evaluation and management of patient for sleep complaints
When providing an enlarged copy of Patients’ insurance card and/or patient Demographic insurance information it is not necessary to complete entire form.