Instructions

Downloading A Blank Copy Of Ez Sleep STOP-BANG/HST Rx Form For Office Use: If you simply wish to download blank copies of the Ez Sleep STOP-BANG form for printing and future in-office use, leave the patient information and screening section blank. It is important that you input your information in the lower right-hand corner on the first page of this document known as the “Practice Information” section of the page. Contact your Ez Sleep Account Executive to order printed copies of your STOP-BANG/HST order form and have them mailed to your office via USPS.

Make sure that all information in the document is correct before submitting.

 

Ordering HST Through The Website: Fill out all of the information fields in the document including the patient information, practice information/screening answers and the doctor signature. It is important that you input your information in the lower right-hand corner on the first page of this document known as the “Practice Information” section of the page. Please do not forget to upload a copy of the patient’s driver’s license and medical insurance card.

 

Click the button below to proceed to your Ez Sleep HST Order Form