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Reason for Referral

Medical History: Please forward most recent history and physical to info@michigansleep.com or fax to 989 345 3163.


Evaluate & Treat, Sleep Testing Only, Apnea Link Screening, CPAP Clinic, DOT Screening.



Excessive Daytime Sleepiness, Snoring, Disruption of Sleep Cycle, Respiratory Distress, Witnessed Apnea.

Patient Information











 Male Female

Referring Physician







 Yes No