PATIENT RESOURCES: Forms & Packets

Download PDF forms used or requested by the Alaska Sleep Clinic.
** Must Know Your MRN to Use This Link Directly. **
Complete Patient Packet Includes the following forms:
Telemedicine Consultation Packet Includes the following forms:

FORMS FOR DOWNLOAD

Bed Partner Form:

Oftentimes, your bed partner knows more about your sleeping habits than you do.

For this reason, we want to hear from them so they can fill us in on any details about your sleeping that you may be unaware of.

Epworth Sleepiness Scale:

The standard scale for making sleep assessments.

This 8 questions self-administered sleep survey gives our clinicians a better understanding of your general daytime sleepiness levels.

Information and Patient Releases:

 

Additional information and sleep study patient release form

Patient Questionnaire:

To help us better diagnose and treat your sleep disorder fill out this detailed questionnaire about your sleep habits,

medical history, day and night symptoms, and other questions to better help our clinicians treat you. 

Pediatric Questionnaire:

To help us better diagnose and treat your little one’s sleep disorder fill out this detailed questionnaire about their sleep habits,

medical history, day and night symptoms, and other questions to better help our clinicians treat your child.

Prior Sleep Study History:

 

If you have previously had a sleep study, please tell us more about your experience by filling out this questionnaire.

Self Referral Form:

When you are interested in working with a board-certified sleep doctor but do not have a direct referral from a provider, this is the form you need.

 Once the quick one-page form is completed, send it back to the Alaska Sleep Clinic of your choice,

we will forward your information to our medical director and we will contact you for further information on setting up your appointment based on the doctor’s recommendations.  

Sleep Diary:

Start keeping track of your sleep troubles by downloading a sleep diary. 

In the diary, you can record important information that can give both you and your primary care physician

a better understanding of your sleep habits, and where any problems may lie.

 

Stop Bang Questionnaire:

 

 

This obstructive sleep apnea screener helps determine your risk of OSA.

 

 

Self Referral Form:

Want to share your experience about living with a sleep disorder and the treatment you received at The Alaska Sleep Clinic?

Download the Testimonial form and share your journey with others.

Maps To Our Facilities

 

 

Need help finding us? Click here for a list of our locations.

 

Brent Fisher, MBA, FACHE, FACMPE
President and Chief Executive Officer

“Alaska Sleep Clinic has a history of providing the most comprehensive sleep medicine services in the state of Alaska. Its potential has only begun. I am here to take these high-quality, comprehensive services to all Alaskans.”

Experience

Brent Fisher has held leadership positions spanning a wide variety of complex and start-up organizations: manufacturing (pharmaceutical & medical device), software development, hospitals (academic and community), medical groups, consulting, hospice, military, engineered devices, engineered plastics, and private equity.

Publications and Organizations

His writings have been published in various magazines, trade journals, and medical journals, including the Physician Executive Journal, Healthcare Executive, Modern Healthcare, Group Practice Journal, New England Journal of Medicine, and Journal of Healthcare Management (Best Article Award).

He has served on the Board of Directors of professional associations, civic organizations, and businesses.

Hobbies and Activities

Brent enjoys being with his family, serving in the community, hiking, camping, fishing, and hunting.