1. Patient Information

Page1 / 4
25% of survey complete.
As you know, your physician recently ordered a diagnostic sleep test through Merit Sleep Centers. In order to expedite the authorization/approval process with your insurance company, and proceed with scheduling the test, it will be necessary to answer several important questions for us. In order to simplify this process and avoid long phone calls, please answer the following questions fully and accurately. Our online questionnaire will take about 10 - 20 minutes to complete. 

Obtaining an authorization from your insurance company normally takes from 3 - 10 business days. In order for us to begin this insurance authorization process, we ask that you please complete this form within the next 48 hours. 

If you have questions or require assistance, please contact our sleep team directly at (630) 652 7900. 

Thank you for help,

Tina Jenkins, RPSGT, RST
Vice President of Clinical Sleep Services

Question Title

* 1. Demographics