Download and Print the order form below to start home sleep testing your patients today. The order can be faxed to our office at 530-691-4051 or emailed to our HIPPA compliant address at Orders must include the following documentation:

  • face to face chart notes from a visit within the past 30 days
  • chart notes must address the patient’s symptoms of sleep apnea
  • patient demographics including up to date contact and insurance information
  • completed Shasta Sleep Services order form with physicians signature and date (per Medicare guidelines stamped - signatures are not accepted)


Common signs of sleep apnea include excessive daytime sleepiness, morning headaches, loud snoring, weight gain, hypertension, diabetes and irritability. It is a good idea to talk to your physician about possible sleep apnea and the option of home sleep testing if you are experiencing any of these conditions.

To streamline the testing process you may print the order form below and take it with you to your next appointment. After discussing your signs and symptoms of sleep apnea your physician will determine if home sleep testing is right for you. To proceed with testing your physician’s office will then fax or email us the order along with the other required documentation as specified on the form.

Please call our office if you have any questions or require assistance with this process: 530-691-4050.