Complete form and submit to order a home sleep test.

FastMed Sleep Test Medical Order
NOTE: After you "submit" this order you will be presented an option to print or save the completed order. Form Version: WEB-FastMed-QF-54805 revA
Please select the option "Location not found on list" if you cannot find your FastMed Clinic location. We will add the location to the list after your first patient referral.

SLEEP TEST PATIENT INFORMATION

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This information is required by health insurance and will improve the time needed to complete the testing process if patient wants to bill their health insurance for the sleep test.

ALTERNATE CONTACT - If available

What is 7+9?

FastMed Sleep Apnea DOT Support Page

You can use the button below to return to the FastMed Sleep Apnea DOT Support page.

NOTE: If you are making an online patient referral, please submit your referral first so you do not lose the information 🙂

DOT Support