Oral Appliance Therapy for Apnea/Snoring Patient Progress Questionnaire The * symbol indicates a required field. Please enable JavaScript in your browser to complete this form.Patient Name *Email *Phone *Date *How many nights per week do you wear your appliance: *Are you able to wear the appliance all night? *YesNoHow many hours per night do you usually sleep? *Is your appliance comfortable when you wear it? *YesNoSince you began Oral Appliance Therapy, your energy level during the day is: *ImprovedUnchangedWorseSince you began Oral Appliance Therapy, you are sleeping: *BetterAbout the sameWorseDo you notice increase in dreaming since you started oral appliance therapy? *YesNoWhen you wake up in the morning, you feel: *Refreshed/RestedTired/SleepySince you began Oral Appliance Therapy, your snoring is: *ImprovedUnchangedWorseNot sureAre you able to reposition your jaw back to normal after removal of your Oral Appliance in the morning? *YesNoDo you use custom AM Repositioner and/or blue bite tab in the morning? *YesNoDo you notice any changes in your bite? *YesNoDo you experience any jaw discomfort? *YesNoDo you experience any tooth pain? *YesNoNotes / Comments:Submit Questionnaire29900