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Request an Appointment

Scottsdale/Phoenix, Arizona
For appointments or more information, contact the Scottsdale Appointment Office at 602-492-9238 between 8 a.m. and 4 p.m. Arizona time Monday through Thursday, or complete the online appointment request form below.

By completing and submitting this form, you can request an appointment.

An appointment agent will call you between 8 a.m. and 4 p.m. Arizona time within 24-48 hours (excluding weekends and holidays) to collect additional information and process your request.

Fields marked with an * are required fields; your request cannot be processed unless these fields are completed.

Patient first name:*
Patient last name:*
Patient address: *
City:*
State/Province/Country:*
Zip code:*
Telephone number (home): *
Telephone number (work):
Fax number:
Please tell us the best time to contact you and which phone number to call:
Date of Birth: * (mm/dd/yy)
Name of requesting individual (if different than patient):
Parent name (if patient is a minor):
Current symptoms:* (emotional, physical, pains, neuromuscular, headaches, stiffness, problems focusing, labored breathing, shortness of breath, snoring, grinding/clinching teeth/jaw, numbness, etc.)
Date of onset or duration of current problem: *
Is this believed to be the result of illness, injury or other: *
How did you hear about our Sleep Treatment Center: *
Recent tests or X-rays (include date of procedure) related with this problem:

My bed partner says my snoring keeps her/him from sleeping.

Yes No

I get very irritable when I can't sleep.

Yes No

I often wake up at night and have trouble falling back to sleep.

Yes No

It usually takes me a long time to fall asleep.

Yes No

I often wake up very early and can't fall back to sleep.

Yes No

I've fallen asleep driving.

Yes No

I feel sleepy during the day, even when I get a good night's sleep.

Yes No

I sometimes wake up gasping for breath.

Yes No
I experience an uncomfortable/restless sensation in my legs at night. Yes No
My legs often move or jerk during the night. Yes No



You will be contacted to review additional medical and financial information, including insurance coverage, before an appointment is offered. If you would like to provide additional information to the appointment office staff, please type it here:
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