Sleep-Wake Disorders Center - Patient Forms - New York City - Montefiore Medical Center

As part of your first visit to the Sleep-Wake Disorders Center, we require that you download and complete the following questionnaire prior to the date of your appointment. In order to provide a thorough evaluation and a personalized treatment plan, we request that you fill out the questionnaire to assist us in understanding your sleep-wake patterns, medical history, and other relevant issues.The sleep diary should be filled out every night for 2 weeks leading up to your appointment. It is mandatory that ALL patients bring the completed questionnaires/diaries to their first appointment. If for some reason you are unable to complete this questionnaire before your office visit, please arrive to your appointment 45 minutes BEFORE your scheduled appointment time.

Please download the appropriate packet to bring in for your session (a staff member at the SWDC will tell you which to download at the time of your appointment). If you are calling for a sleep apnea evaluation,download the "Sleep Apnea Initial Forms" (there are 2 files in this zip file). If you are calling for insomnia (or if you are unsure which packet to download), download the "Insomnia Initial Forms " packet (there are 2 files in this zip file).


Sleep Apnea Initial Forms (zip format)

Insomnia Initial Forms (zip format)

Thank you, and please call 718-920-4841 to speak with a Sleep-Wake Disorders Center staff member if you have any questions.