Sleep Diagnostic Scoring Enquiry
*
Facility Name :
*
Contact Person's Name :
Dr
RPSGT
Mr
Mrs
*
E-mail Address :
*
Phone Number (xxx) xxx-xxxx :
Mobile Number :
Fax Number (xxx) xxx-xxxx
*
How many studies per day on average would
you need to have scored ?
*
What sleep software do you currently utilize?
Would you need us to also do reports with
each study?
Yes
No
Is 24-48 day turnaround time post reception of
your study adequate?
Yes
No
Does your facility have high speed internet
access?
Yes
No
How do you prefer us to perform scoring Studies?
File uploaded through FTP
Remote scoring
When do you want to start your project ?
Not Selected
Right Away
In 2 weeks
In One month
More than One month
At what stage are you in the outsourcing process ?
Not Selected
Gathering information
Decided to Outsource
Ready right now
How would you prefer we contact you?
Email
Phone
Fax
Best time to call
AM
PM
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We score using following softwares...
Allice
Bio Logic
Cadwell
Clevemed
Compu Medics
Embla
Embletta
TM
Exel Tech
Grass
LX Sleep
Nihon Kohden
Rembrandt
Sandman Elite
Somnologica
Typical polysomnogram
tracing
Typical polysomnogram
summary