PATIENT FORMS

STRC PATIENT PORTAL

PATIENT FORMS

OFFICE VISIT FORMS

• • New Patient Visit Questionnaire
  • Follow-Up Visit Questionnaire

OVERNIGHT SLEEP STUDY VISIT

• • Sleep Study Consent Form & Questionnaire
  • Patient Information Form
  • Authorization for Release of Medical Records
  • Individual Questionnaires

INDIVIDUAL QUESTIONNAIRES

• • New Patient Questionnaire
  • Follow-Up Visit Questionnaire
  • Berlin Questionnaire (STRC Modified)
  • Sleep Questionnaires – English
  • Dental STOP-BANG-GO & Mallampatti
  • Idiopathic Hypersomnia Severity Scale
  • Insomnia Severity Index
  • Good Sleep Hygiene Tips

OTHER FORMS

• • Controlled Substance Agreement

 

SLEEP STUDY – PATIENT INSTRUCTIONS AND LOCATION GUIDE

NORTHWEST – MEDICAL CENTER

MEDICAL CENTER – 5290 Medical Drive, San Antonio, Texas 78229

Patient Instructions & Map

NORTHEAST – STONE OAK

STONE OAK  – 19222 Stonehue, San Antonio, Texas, 78258

Patient Instructions & Map

 SOUTHWEST – SW GENERAL AREA

BARLITE – 7940 Barlite Blvd., San Antonio, Texas 78224

Patient Instructions & Map

 

PAP SETUP:

• FILLABLE & PRINTABLE ORDER FORM
• PATIENT DME INFO
• HGNS REMOTE THERAPEUTIC MONITORING CONSENT FORM
• PAP DELIVERY TICKET & RTM FORM
• REMOTE THERAPEUTIC MONITORING CONSENT FORM
• PHILIPS RECALL DELIVERY TICKET