For Physicians/Dentists

Helping Health Practitioners With Patients in Need of a Sleep Test

At Complete Sleep Relief, we are dedicated to helping our providers with their in-home sleep needs. Our team services providers nationwide.

Order Your Test Today

Download form

Patient Name
First Last
- Male
- Female
DOB
MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Insurance
Preferred DME Company
Type of Referral
- 2-night In-Home Sleep Study (HST) 95800/95806/G0399
- 2-night In-Home Sleep Study With Consult (Sleep Doctor will order therapy and maintain compliance after testing is completed)
- 2-night In-Home Sleep Study with Oral Appliance (HST) 95800/95806/G0399
- Sleep Consultation (Sleep Doctor will consult with your patient and order testing or therapy as needed)
Diagnosis
- OSA G47.33 (Select this option to rule in/out OSA)
- Other
others
**Insurance Requirements**
- Current chart notes/Sleep Questionnaire (notes must be within 90 days of this order date)
- Demographics (patient’s address, insurance information)
- Copy of front and back of the patient’s insurance card
Ordering Physician
Physician Printed Name
NPI#
Signature
Date
MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Fax

An Excellent Support Team

Our process is contactless, safe, and secure for all patients.
Your patient is tested in the comfort of their home, capturing the most natural night of sleep, and avoiding the high cost of facility testing.
Results of the in-home sleep study are returned to the ordering provider within 2 business days of receiving the device.
All in-home sleep studies are interpreted by a Board-Certified Sleep Physician. Diagnoses and treatment recommendations will be provided.
Patients are provided with two nights of in-home testing for better results. This includes night to night variation and to ensure enough data is collected to make a diagnosis.
Our office informs the patient of any out-of-pocket costs not covered by insurance prior to scheduling. We also obtain the authorizations necessary for testing.
Patients are contacted within 1 business day of obtaining the order.
Our priority is to exceed patient and client expectations of patient care and service.

Our Commitment

At Complete Sleep Relief, we provide you and your patients with convenient and cost-effective sleep testing. We are committed to providing the best patient experience possible.

Check your Sleep Score- Take Our Sleep Questionnaire Now

Welcome to Complete Sleep Relief A Simple Sleep Testing Solution

For Physicians/Dentists

Helping Health Practitioners With Patients in Need of a Sleep Test

Ordering Physician

An Excellent Support Team

Our Commitment

Registration Information

Patient Consent for Treatment/Assignment of Benefits Agreement/Costs

PATIENT SERVICE AGREEMENT AND PLAN OF SERVICE- SLEEP TESTING

HIPAA PATIENT ACKNOWLEDGEMENT

PLAN OF SERVICE

INSTRUCTIONS ON HOW TO USE THE DEVICE: Resmed ApniaLink Air

HIPAA PRIVACY NOTICE