Am I a Candidate Toluca Lake location Complete a simple online self-assessment: Please enable JavaScript in your browser to complete this form. - Step 1 of 3Name *FirstLastEmail * I acknowledge that this self-assessment is not designed to diagnose, treat, prevent, or cure any health condition and is for information only.YesNextDo you experience any of the following?Clinical DepressionGeneralized AnxietyChronic AllergiesEarly Signs of Alzheimer'sEarly Signs of DementiaAggressionAttention Deficit DisorderWhat about any of the signs of an unhealthy cardiovascular system?HypertensionHeart DiseaseChronic FatigueHeart PalpitationsCardiovascular DiseaseDo you have any symptoms of an unhealthy body?SnoringCancerObesityMouth BreathingHypothyroidismHeadachesDiabetesFibromyalgiaChronic PainDo you experience any of the following during sleep?SnoringGasping EpisodesChoking or CoughingRestless SleepRestless Leg SyndromeInsomniaDuring the day, do you experience any of the following?Chronic FatiguePersistent YawningSleepinessChronic PainSoreness in HandsSoreness in FeetSelect all that apply:I have had my wisdom teeth extracted.I have had other adult teeth extracted.I wore braces to straighten my teeth.I probably should have worn braces.I have had my tonsils removed.I have had my adenoids removed.NextHave you been diagnosed by a physician with mild-to-moderate obstructive sleep apnea or sleep-disordered breathing?YesNoHas anyone ever told you that you stop breathing while you are sleeping?YesNoDo you currently take medications for any of the following:HypertensionDepressionAnxietyGastric RefluxHeart DiseaseADHDChronic PainHave you ever taken a home sleep study?YesNoWhat were the results?Has a doctor ever prescribed the use of a CPAP machine?YesNoHave you ever heard of maxillo-mandibular hypoplasia?YesNoWould you like to speak directly with a Breathing Wellness advocate?YesNoSubmit