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Department of Neurology

Sleep Medicine Center

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  • Home
  • Meet Our Providers
  • Disorders and Treatments
    • Do I Have A Sleep Disorder?
    • Common Sleep Disorders
    • Types of Sleep Study Tests
    • Treatment Options
    • Frequently Asked Questions
  • Patient Resources
    • Preparing for a Sleep Study
    • Equipment Loan Program
    • Instructional Videos
    • Tips for Sleeping Well
    • Patient Forms
    • Health Insurance Plans Accepted
    • Glossary
  • Fellowship
    • Application and Selection of Fellows
    • Training Sites for the Fellowship
    • Day in the Life of the Fellow
    • Information about Washington University School of Medicine
    • Information about St. Louis, Missouri
    • Sleep Medicine Fellows 2015-Present
  • Research
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      • Map & Directions
      • Parking
      • Nearby Hotels
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Patient Forms

The forms listed below are available in a printable version for you to complete in advance and bring to your next office visit.

You will need at least Adobe Acrobat 5.0 to view and print these forms. If you do not have it, please click on the Adobe Reader icon to download.

  • New Patient History and Physical (PDF)
  • Follow Up Form (DOC)
  • Epworth Sleepiness Scale
  • Stop-Bang Questionnaire
  • Access to Health Information Release (PDF)
  • Authorization to Release Health Records
  • Patient Resources
    • Preparing for a Sleep Study
    • Equipment Loan Program
    • Instructional Videos
    • Tips for Sleeping Well
    • Patient Forms
    • Health Insurance Plans Accepted
    • Glossary

Sleep Medicine Center
Washington University School of Medicine
1600 S. Brentwood Blvd., Suite 600 | St. Louis, MO 63144
Phone: 314-362-4342
Fax: 314-747-3813

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