Name First Last Email How would you rate your SLEEP over the last few weeks while using your CPAP Therapy? Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied Are you experiencing any of the following constantly in the last month? Humidity Issues (e.g. Dry mouth, too much moisture, hose condensation) Tiredness Air Leaking from Mask Snoring with Mask on Too Much Pressure at times Not Enough Pressure at times Machine Noisy or Whistling sound Other reason Please describe the issue you are havingHave you replaced your mask, or cushion or headgear in the last 12 months? Yes No Do you need a CPAP report for your Doctor / Specialist? Yes No Best Contact Phone NumberDo you have any questions or feedback? No Yes If Yes, what is your comment or questions? Name First Last Email How would you rate your SLEEP over the last few weeks while using your CPAP Therapy? Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied Are you experiencing any of the following constantly in the last month? Humidity Issues (e.g. Dry mouth, too much moisture, hose condensation) Tiredness Air Leaking from Mask Snoring with Mask on Too Much Pressure at times Not Enough Pressure at times Machine Noisy or Whistling sound Other reason Please describe the issue you are havingHave you replaced your mask, or cushion or headgear in the last 12 months? Yes No Do you need a CPAP report for your Doctor / Specialist? Yes No Best Contact Phone NumberDo you have any questions or feedback? No Yes If Yes, what is your comment or questions?
