Online Order

Complete the form below and submit to order a DropShip Home Sleep Test

Complete form and submit to order a home sleep test.

DROPSHIP - Home Sleep Test Order
NOTE: After you "submit" this order you will be presented an option to print or save the completed order. Form version: WEB-QF-54805 revA

HEALTHCARE PRACTICE INFORMATION

A sleep test is governed by the FDA to require a prescription by a licensed healthcare provider.

PATIENT INFORMATION

Completion of this section is critical for a timely testing session.
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This information is required by health insurance and will improve the time needed to complete the testing process, when the patient wants to bill their health insurance for the sleep test.

ALTERNATE CONTACT FOR PATIENT (Optional)

An alternative contact can assist Snap in reaching the patient in a timely manner.

PROVE YOU'RE HUMAN

What is 7+6?

Thanks for the referral. We’ll take it from here.

What happens next?

One of our support team members will reach out to your patient. After speaking with the patient we will send a Snap Home Sleep Test kit to the patient’s home.

The sleep test is simple to operate. Video and written instructions are included on how your patient can successfully perform the test. Patients also have access to our toll-free support line.

Your patient will be instructed to return the kit to Snap as soon as the testing is complete.

A professionally trained technician will manually score the completed test and a licensed medical professional will review the test results.

The resultant Snap Test report will be sent to the healthcare provider that ordered the test.