Complete form and submit to order a home sleep test. After the Ordering Provider authorizes the Medical Order, we will ship the test kit to your patient’s home.

DROPSHIP - Home Sleep Test Order
Completion of this Medical Order form is critical for a timely testing session. NOTE: After you "submit" this order you will be presented an option to print or save the form. Form version: WEB-QF-54805 rev B

HEALTHCARE PROVIDER INFORMATION

A sleep test is governed by the FDA to require a prescription by a licensed healthcare provider.
This option allows you to determine how to obtain a signature on the Medical Order.

PATIENT INFORMATION

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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.

NOTE: Patients also have the option to register online. If you provide us the patient’s cell phone and email address in the online form we will text and/or email a link to the online registration form for your patient’s convenience.

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.

OPTIONAL REQUEST: When testing is completed, if you want Snap to send the Snap Test Report to the preferred DME treatment provider, please indicate the DME contact inormation on the order form where indicated.