Sleep apnea intake that captures snoring, breathing pauses, and sleepiness
Every intake captures the symptom pattern (snoring, breathing pauses, daytime sleepiness), current diagnosis status, and whether the patient can attend in person, along with any prior sleep study records on file.
Preview your sleep apnea evaluation intake
Explore 5 questions from the Sleep Apnea Evaluation template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified sleep apnea evaluation lead should tell you
A structured intake that captures sleep-related symptoms, prior testing history, and relevant health conditions to determine whether a patient should be scheduled for a sleep apnea evaluation.
- This Evaluation
- Sleep Symptoms Have Been
- Current Status Any Sleep
- There Any Existing Heart,
- Able Attend In-Person Appointment
The questions your team needs answered
Every sleep apnea evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this evaluation for? | Identifying whether the evaluation is for a self-referral, a child, or another adult determines how consent and follow-up communication should be routed. |
| Which sleep symptoms have been noticed? | Each symptom carries a different weight, so a cluster of high-risk signs like breathing pauses and daytime sleepiness scores well above a single mild complaint. |
| What is the current status of any sleep apnea diagnosis or testing for this person? | Diagnosis status separates patients who need a first evaluation from those who are already diagnosed and likely need a different type of visit. |
| Are there any existing heart, lung, or weight-related health conditions relevant to sleep? | Existing heart, lung, or weight-related conditions give clinicians relevant context that can affect how the evaluation is prioritized. |
| Are you able to attend an in-person appointment for this evaluation? | In-person availability is weighted on its own, so patients who can't attend in person are flagged before a physical slot is booked for them. |
How Cliont scores sleep apnea evaluation leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Loud snoring
- Pauses in breathing during sleep
- Excessive daytime sleepiness
- Morning headaches
- Able Attend In-Person Appointment: yes
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Sleep Apnea Evaluation Lead
From first click to qualified lead
Follow patients and caregivers through one smooth, guided flow.
They land & meet you
Your video greeting plays instantly — a real face instead of a blank form.
They explain the visit
Smart questions adapt to their visit and capture the full scope.
They share details
Symptoms, history, and documents come attached before the visit.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for sleep apnea evaluation workflows
| Cliont capability | Sleep Apnea Evaluation application |
|---|---|
| Weighted multi-select symptom capture | Breathing pauses and loud snoring carry more weight than morning headaches, so a multi-symptom cluster consistent with sleep apnea risk scores meaningfully higher than an isolated complaint. |
| Diagnosis-status branching | Distinguishes never-evaluated patients from those already diagnosed with sleep apnea, so front desks don't book a first-evaluation slot for someone who actually needs CPAP follow-up. |
| Attendance eligibility scoring | The in-person attendance question carries its own weight, so patients who can't attend in person are surfaced for a telehealth conversation before a physical slot is confirmed. |
| Guardian/proxy identification | Captures whether the evaluation is for the respondent, their child, or another adult they care for, so consent forms and communications route to the correct person automatically. |
Example sleep apnea evaluation lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Classic high-risk symptom cluster
Loud snoring, witnessed breathing pauses, and daytime sleepiness together push the score up sharply, and a confirmed in-person availability marks the lead ready to book.
Parent evaluating a child
When the intake identifies the patient as a child rather than the adult filling out the form, the lead routes differently for consent and scheduling than a self-referral.
Already-diagnosed patient reaching out
A patient who marks 'already diagnosed with sleep apnea' isn't a new-evaluation lead — the intake flags them so staff can redirect toward CPAP management instead of booking a first evaluation slot.
Symptom-light, exploratory inquiry
Selecting 'none noticed yet' for symptoms produces a lower score than a multi-symptom cluster, helping staff separate curious inquiries from patients showing real warning signs.
Can't attend in person
A 'no' on in-person attendance carries a lower weight than a 'yes,' surfacing the lead for a telehealth conversation before a physical slot gets booked and wasted.
Connect Cliont to your workflow
Connect your CRM
HubSpot, HighLevel, monday.com
Connect your legal software
Lawmatics, MyCase, Clio Manage and Clio Grow
Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
Simple, transparent pricing
Choose the plan that works for your business.
Professional
Unlimited intake forms and leads for your growing business.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Advanced analytics dashboard
Pay Per Lead
Only pay when you receive a qualified lead.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Charged only for submitted leads
More sleep medicine intake templates
Sleep Apnea Evaluation lead-intake FAQs
How does the intake score sleep apnea symptoms?
Each symptom in the multi-select list carries its own weight — breathing pauses and loud snoring score higher than a single symptom like morning headaches — so a patient reporting multiple high-risk signs ranks well above someone with one vague complaint.
What happens if the patient is already diagnosed with sleep apnea?
The intake records diagnosis status separately from symptoms, so an already-diagnosed patient can be flagged and routed toward follow-up or CPAP management rather than filling a first-evaluation slot meant for undiagnosed patients.
Can this intake be used when someone is booking for a family member?
Yes — the intake asks whether the evaluation is for the person filling out the form, their child, or another adult they care for, so consent and communication can be routed to the right person from the start.
What if a patient says they can't attend in person?
In-person availability is a weighted yes/no question, so a 'no' answer scores lower than a 'yes' and flags the lead for a telehealth option instead of getting booked into an in-person slot the patient can't keep.
Does the intake capture relevant health conditions?
Yes — a yes/no question asks about existing heart, lung, or weight-related conditions relevant to sleep, giving clinicians context on the patient's health background before the first appointment.
How is this different from the Snoring Evaluation or Daytime Sleepiness intakes?
This intake covers the fuller sleep apnea symptom set and prior testing status together, while the Snoring Evaluation and Daytime Sleepiness pages focus the intake on a single presenting complaint.
Turn sleep apnea evaluation visitors into qualified patients
Give every sleep apnea evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.