New Patient Medical History Information

New Patient Medical History Information

Please complete the below questionnaire and return on completion.

Have you consulted with any of the following?

Respiratory Specialist *
Cardiologist *
Neurologist *
Ear Nose & Throat Specialist *
Oncologist *
Rheumatologist *
Thoracic Surgeon *
Other Specialists *

Have you had any Operations or Procedures?

Have you had any of the following testing?

Respiratory Function Test *
Sleep Study *
Cardiology Investigations *
Pathology or Blood Testing *
Radiology (I.e.-X-Ray, Ultra Sound, CT etc.) *
Other Specialists *
Are you on a Continuous Positive Airway Pressure (CPAP) Device? *
Are you on a Bilevel Positive Airway Pressure (BiPAP) Device? *

Thank you for taking the time to complete this questionnaire.

Summary