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Am I a Candidate?
Complete a simple online self-assessment.
Please enable JavaScript in your browser to complete this form.
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Step
1
of 3
Name
*
First
Last
Email
*
I acknowledge that this self-assessment is not designed to diagnose, treat, prevent or cure any health condition and is for information only.
Yes
Next
Do you Experience any of the following?
Clinical Depression
Generalized Anxiety
Chronic Allergies
Early Signs of Alzheimer's
Early Signs of Dementia
Aggression
Attention Deficit Disorder
What about any of the signs of an unhealthy cardiovascular system?
Hypertension
Heart Disease
Chronic Fatigue
Heart Palpitations
Cardiovascular Disease
Do you have any symptoms of an unhealthy body?
Snoring
Cancer
Obesity
Mouth Breathing
Hypothyroidism
Headaches
Diabetes
Fibromyalgia
Chronic Pain
Do you experience any of the following during sleep?
Snoring
Gasping Episodes
Choking or Coughing
Restless Sleep
Restless Leg Syndrome
Insomnia
During the day, do you experience any of the following?
Chronic Fatigue
Persistent Yawning
Sleepiness
Chronic Pain
Soreness in Hands
Soreness in Feet
Select all that apply:
I have had my wisdom teeth extracted
I have had other adult teeth extracted
I wore braces to straighten teeth
I probably should have worn braces
I have had my tonsils removed
I have had my adneoids removed
Next
Have you been diagnosed by a physician with mild-to-moderate obstructive sleep apnea or sleep disordered breathing?
Yes
No
Has anyone ever told you that you stop breathing while you are sleeping?
Yes
No
Do you currently take medications for any of the following:
Hypertension
Depression
Anxiety
Gastric Reflux
Heart Disease
ADHD
Chronic Pain
Have you ever taken a home sleep study?
Yes
No
What were the results?
Has a doctor ever prescribed the use of a CPAP machine?
Yes
No
Have you ever heard of Maxillo-Mandibular Hypoplasia?
Yes
No
Would you like to speak directly with a Breathing Wellness advocate?
Yes
No
Submit
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Sleep + Health
Why Do We Sleep?
The Vivos System
The Difference
How It Works
Am I a Candidate?
Better Sleep. Better Health.
Sleep + Health
Why Do We Sleep
The Vivos System
Sleep Diagnostics
The Vivos Difference
How it Works
Am I a Candidate
Research
Find a Provider
Investor Relations
Leadership
Stock Data
SEC Filings
Governance
Media
News + Events
Become a Vivos Provider
Provider Login
Contact Us