A New Dental Experience is Waiting For You

Take-home Survey for Pediatric/Adult Sleep Apnea

Milford Dental Excellence

Take-home Survey for Pediatric/Adult Sleep Apnea

[fusion_builder_container hundred_percent=”no” equal_height_columns=”no” menu_anchor=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” video_preview_image=”” border_size=”” border_color=”” border_style=”solid” margin_top=”” margin_bottom=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=””][fusion_builder_row][fusion_builder_column type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” hover_type=”none” link=”” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_position=”left top” background_repeat=”no-repeat” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” padding=”” dimension_margin=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”no”][fusion_text]

Take-home Survey for Adult Sleep Apnea

Epworth Sleepiness Scale (ESS)

Click here for a quick self-assessment test for adults you can take to identify whether you may be at risk for Sleep Apnea and the associated health conditions.

[/fusion_text][fusion_button link=”/sleep-apnea-survey” title=”” target=”_self” link_attributes=”” alignment=”” modal=”ess” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” color=”default” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” border_width=”” size=”” stretch=”default” shape=”” icon=”” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Adult Sleep Apnea Survey[/fusion_button][/fusion_builder_column][fusion_builder_column type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” hover_type=”none” link=”” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_position=”left top” background_repeat=”no-repeat” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” padding=”” dimension_margin=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”no”][fusion_text]

Children and Disordered Sleep

Good sleep is critical to the physical and cognitive development of your child. The first symptom associated with a child experiencing sleep issues is grinding of their teeth!

Please review the following questionnaire to help evaluate the current sleep and airway health of your child.

[/fusion_text][fusion_checklist icon=”fa-question-circle” iconcolor=”” circle=”” circlecolor=”” size=”13px” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””][fusion_li_item icon=””]

While sleeping, does your child snore more than half the time?

[/fusion_li_item][fusion_li_item icon=””]

While sleeping, does your child always snore?

[/fusion_li_item][fusion_li_item icon=””]

While sleeping, does your child snore loudly?

[/fusion_li_item][fusion_li_item icon=””]

While sleeping, does your child have “heavy” or loud breathing?

[/fusion_li_item][fusion_li_item icon=””]

While sleeping, does your child have trouble breathing, or struggle to breathe?

[/fusion_li_item][fusion_li_item icon=””]

Have you ever seen your child stop breathing during sleep?

[/fusion_li_item][fusion_li_item icon=””]

Does your child experience nightmares or bad dreams?

[/fusion_li_item][fusion_li_item icon=””]

Does your child tend to breathe through their mouth during the day?

[/fusion_li_item][fusion_li_item icon=””]

Does your child have dry mouth upon awakening in the morning?

[/fusion_li_item][fusion_li_item icon=””]Does your child occasionally wet the bed?[/fusion_li_item][fusion_li_item icon=””]

Does your child wake up tired in the morning?

[/fusion_li_item][fusion_li_item icon=””]

Does your child experience sleepiness during the day?

[/fusion_li_item][fusion_li_item icon=””]

Has a teacher or supervisor commented that your child appears sleepy or sluggish during the day?

[/fusion_li_item][fusion_li_item icon=””]

Is it hard to wake your child in the morning?

[/fusion_li_item][fusion_li_item icon=””]

Does your child wake up with a headache?

[/fusion_li_item][fusion_li_item icon=””]

Did your child ever stop growing at a normal rate?

[/fusion_li_item][fusion_li_item icon=””]

Is your child overweight?

[/fusion_li_item][fusion_li_item icon=””]

Does your child not seem to listen when spoken to directly?

[/fusion_li_item][fusion_li_item icon=””]

Is your child easily distracted?

[/fusion_li_item][fusion_li_item icon=””]

Does your child often have difficulty organizing tasks and activities?

[/fusion_li_item][fusion_li_item icon=””]

Does your child fidget or squirm?

[/fusion_li_item][fusion_li_item icon=””]

Does your child act as if “motor driven” or seem to always be “on the go”?

[/fusion_li_item][fusion_li_item icon=””]

Does your child often interrupt or intrude?

[/fusion_li_item][/fusion_checklist][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container][fusion_builder_container hundred_percent=”no” equal_height_columns=”no” menu_anchor=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” video_preview_image=”” border_size=”” border_color=”” border_style=”solid” margin_top=”” margin_bottom=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=””][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” hover_type=”none” link=”” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_position=”left top” background_repeat=”no-repeat” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” padding=”” dimension_margin=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”no”][fusion_modal name=”ess” title=”Epworth Sleepiness Scale (ESS) Quiz” size=”large” background=”” border_color=”” show_footer=”no” class=”” id=””]

[qsm quiz=1]

[/fusion_modal][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]