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Do you snore? (required)

YesNoI don't know

Has anyone noticed that you stop breathing when you're sleeping? (required)

YesNoI don't know

During your waking time, do you feel tired, fatigued or not up to par? (required)

YesNoI don't know

Have you ever nodded off or fallen asleep while driving a vehicle? (required)

YesNoI don't know

Do you have a chance of dozing in these situations:

Sitting and reading? (required)

YesNoI don't know

Sitting and talking? (required)

YesNoI don't know

Watching television? (required)

YesNoI don't know

Sitting inactive in a public place such as a theater or meeting? (required)

YesNoI don't know

In a car while stopped in traffic? (required)

YesNoI don't know

Do you have high blood pressure? (required)

YesNoI don't know



If you have answered YES to 2 or more of the questions above, then you are at high risk for a sleep disorder.

If you have answered YES to 1 question, you are at moderate risk of a sleep disorder.


Would you like a sleep specialist from SleepWerx to contact you? (required)


Best time to call? (required)


Name of Insurance Provider

Phone number of Insurance Provider

Subscriber ID #

Group number

First and Last name (required)

Your email (required)

Best number to reach you

Date of Birth (required)

How did you hear about us? (required)

Please specify if you selected other

Appointment Request

If you wish to book an appointment with a doctor, it is best that you visit the Appointment Booking Page directly.

Located in Northeast Mesa Arizona

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Contact Info & Details

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SleepWerx is conveniently located less than a mile north of the 202 freeway, on the Southwest corner of Power and Thomas Rds., in northeast Mesa. There are two convenient entrances to our complex:  one off Power Rd., and one off Thomas Rd. We are in Suite 127, in the Selina Ashworth building.

Business hours:

Monday-Friday 7am – 4pm

Saturday by appointment only

Closed Sunday


PHONE: (480) 571-8460

FAX: (480) 571-8461


3514 N POWER RD. STE. 127

MESA, AZ 85215

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Mesa Sleep Clinic

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