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STOP-BANG Sleep Apnea Screening

Asks about do you snore loudly, do you often feel tired during the day, and has anyone observed you stop breathing during sleep. Built for pre-operative anesthesia sleep apnea risk assessment.

Questions
12
Pages
2
Time
about 3 min
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STOP-BANG Sleep Apnea Screening

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Pre-operative anesthesia sleep apnea risk assessment
  • Primary care screening for patients with hypertension or obesity
  • Sleep medicine referral and triage workflows
  • Occupational health screening for safety-sensitive positions

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What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Patient NameText · Required
  2. Date of BirthDate
  3. Do you Snore loudly?Multiple Choice · 3 choices
  4. Do you often feel Tired during the day?Multiple Choice · 3 choices
  5. Has anyone Observed you stop breathing during sleep?Multiple Choice · 3 choices

Page 2 · Additional details

  1. BMI greater than 35?Long Text
  2. Age over 50 years?Long Text
  3. Neck circumference greater than 40 cm?Long Text
  4. GenderLong Text
  5. STOP-BANG Total ScoreNumber

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the STOP-BANG Sleep Apnea Screening, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The STOP-BANG Sleep Apnea Screening works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the STOP-BANG Sleep Apnea Screening to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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