Patient / Physician Referral Request

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    Patients must have an OSA50 score ≥5 and an ESS score ≥ 8 to be eligible for a Medicare rebated at-home sleep study (item 12250).

    How likely is the patient to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to their usual way of life in recent times. Even if they have not done some of these things recently try to work out how they would have affected them.


    LikelyMaybeUnlikelyVery Unlikely


    LikelyMaybeUnlikelyVery Unlikely


    LikelyMaybeUnlikelyVery Unlikely


    LikelyMaybeUnlikelyVery Unlikely


    LikelyMaybeUnlikelyVery Unlikely


    LikelyMaybeUnlikelyVery Unlikely

    Investigations / Consultations Requested

    The patient qualifies for a medicare funded at home level 2 sleep study, the first step to a good night's sleep. Please fill out your details here to request more information.


    Level 2 Sleep Study with the SleepGP Consultation / TreatmentLevel 2 Sleep Study only

    Patient Details



    Clinician Details

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