Email Helpline

    Title

    First Name

    Last Name

    Email

    Telephone Number

    Address

    Postcode

    Sleep Clinic (or write “None” if you do not have one)

    What type of sleep apnoea do you have? (or write NA = not applicable)

    What severity of Sleep Apnoea? (Mild, Moderate or Severe)

    When was your sleep apnoea diagnosed? (or write NA = not applicable)

    What was your Epworth Sleepiness Score when you were referred?

    Were you diagnosed with excessive sleepiness/excessive daytime sleepiness/excessive daytime somnolence?

    Were you told not to drive by a medical professional until compliant with CPAP therapy?

    Were you told to contact the DVLA before you started your CPAP therapy?

    When you informed the DVLA did you use the paper method or the online system?

    When did you start CPAP/or MAD therapy? (or write NA = not applicable)

    Make & Model of CPAP machine or write “None” (if you do not have one)

    How old is you CPAP machine? (or write NA = not applicable)

    Make & Model of CPAP mask (or write “None” if you do not have one)

    Make and Model of Mandibular Advancement Device (or write “None” if you do not have one)

    Enquiry

    How the Trust Helps

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