VivoScore Interpretation request

Home Sleep Test Reading Request

Remember to share the patient's sleep test with care@empowersleep.com
Referring Doctor Information
Dental office name
Dental office phone number
Please enter a valid phone number.Format: (000) 000-0000.
Dental office email
example@example.com
Patient Information
Patient name

First NameLast Name
Patient Home State
Patient date of birth

MonthDayYear
Date of birth
Date of home sleep test to be interpreted (date, when the patient woke up)

MonthDayYear
Patient email: To make it easy for you, we're happy to send the patient their report directly and cc your office. You can also skip this.
example@example.com
Type of Home Sleep Test

Other
Patient Vivos Score ID number
Type of home sleep test

Other
What's is the indication for a sleep test (epworth, STOPBANG, etc.)? This will be helpful to ensure a personalized report
Upload additional clinical information. No need to upload HST report if it's been shared through SleepImage/Cloudpat.

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📣 Announcement: We've launched educational & personalized home sleep test reports! View a sample report here.
Do you want an educational & personalized HST report to share with your patient? There is no additional cost!

Home Sleep Test Interpretation (Report only)

HSTs will be interpreted within 72 business hours. Please don't forget to share the request in SleepImage or CloudPAT with care@empowersleep.com

$75.00

Enter coupon

Total

Home Sleep Test Reading Request