Buy - Snore Owl

Name*

First

Last

Email*

What city do you live in?

Have you been diagnosed with Sleep Apnea?*

If Yes – what was your diagnosis?

Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?*

Has anyone observed you stop breathing during your sleep?*

Do you often feel tired, fatigued, or sleepy during the daytime?*

Do you have or are you being treated for high blood pressure?*

Do you have asthma, emphysema, or other serious respiratory disease?*

Have you had a heart attack or stroke?*

Dental Question #1: Do you have loose / sore teeth, or gum disease?*

Dental Question #2: Do you have full upper and/or lower dentures?*

Dental Question #3: Do you have Dental Implants?*

Dental Question #4: Have you been diagnosed with jaw pain issues ie: Temporomandibular Joint (TMJ) problems?*

How did you first find out about the Snore Owl?

Other questions or comments that you may have:

Stop Snoring. Guaranteed.