Refer a Patient

Refer a Patient to Sleepscope.

Using the electronic form, you can seamlessly refer a patient to Sleepscope. Simply fill in the necessary information and press the submit button.

Note: If you also want to refer cardiac services as well, you can do it through this form. 

Heartscope Sleep Referral

Patient's Details
Patient's Sex
Conditions/Symptoms (Please Tick Appropriate Boxes Below)

Sleep and Respiratory Services
Select Referral Type
Patient Category
Preferred Respiratory & Sleep Disorders Physicians
(Combined Spirometry & Gas Transfer Factor)
Home based Sleep study (MBS 12250) For suspected sleep apnea. If deemed necessary, a Sleep Physician appointment may be arranged, who will arrange appropriate treatment if required. Once selected, please fill out the questionnaire below.

For Sleep Investigation, you must please complete the questionnaire below:


The Epworth Sleepiness Scale Test

How likely are you to doze off or fall asleep in the situations described, in contrast to feeling just tired?

This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently, try to work out how they have affected you. Use the scale test on the left to choose the most appropriate number for each situation.

0 - Would never doze
1 - Slight chance of dozing
2 - Moderate chance of dozing
3 - High chance of dozing

Score Result:

0 - 7 = Normal  (Bulk billing not applicable)

8 - 24 = Abnormal  (Complete questionnaire below)

Results have shown to be abnormal. Please complete only one of the questionnaires below to determine if the patient is eligible for bulk-billing.

Stop - Bang Sleep Apnea Questionnaire for Patient (Minimum 3 ticks to qualify):
Do you SNORE loudly (loud enough to be heard through closed doors?)
Do you often feel TIRED, fatigued or sleepy during anytime?
Do you have or are you being treated for high blood PRESSURE?
Has anyone OBSERVED you stop breathing or choking during your sleep?
BMI more than 35kg/m2?
NECK size large (Males: 43cm+ & Females: 41cm+)?
SEX = male?
Must be equal or greater than 3 to be eligible for bulk billing. If patient has not met the criteria, consider the OSA 50 Screening questionnaire.

The results meet requirements for bulk billing.

OSA 50 Screening Questionnaire (Minimum score of 5 to qualify):
Confirm Sex
Waist measurement at the umbilicus level in (cm). To be eligible: Weight circumference must be: Males > 102cm; Females > 88cm
Snoring: Has your snoring ever bothered other people? (3 points)
Apneas: Has anyone noticed that you stop breathing during sleep? (2 points)
Age 50+: Are you aged 50 years or over? (2 points)
Must be greater than or equal to 5 to be eligible for bulk billing. If patient has not met the criteria, consider the Bang Sleep Apnea Questionnaire.

The results meet requirements for bulk billing.


Once you have finished, please proceed to the next page if you have received the confirmation of meeting the bulk billing requirements.

If you have filled out both forms and none of them have met the requirements, you can also continue to the next page. It will just mean that your patient will not be bulk billed.