University Services has trials currently underway which may be of interest to you. Participants may be reimbursed for their time and travel. If you’d like, fill out the form below or contact our research coordinator today to get started.
When you are done click Submit.
Is this entry for a pediatric patient? If so, please enter the child's information below: No Yes
First Name:
Last Name:
Date of Birth:
Phone #:
Address City: State: Zip:
Are you a University Services patient? No Yes
If so, at which facility were you seen?: ----------------------------------- Northeast Philadelphia West Chester Lansdale Warrington Pottstown Voorhees
Have you been diagnosed with a sleep disorder? No Yes
If yes, what disorder? Sleep Apnea Narcolepsy Restless Leg Syndrome Shift Work Sleep Disorder Insomnia Periodic Limb Movement Disorder REM Behavior Disorder Other
What sleep symptoms do you currently have? Snoring Pauses in breathing while asleep Choking or gasping for air while asleep Excessive daytime sleepiness Difficulty falling asleep Difficulty staying asleep Early morning awakenings Sleep paralysis (waking up during the night and unable to move for a brief period) Sleep attacks during daily activities Cataplexy (muscle weakness often occurring during periods of excitement or stress) Uncomfortable feeling in your legs at bedtime Twitching or kicking legs while asleep Acting out dreams
Are you currently receiving any treatment for sleep disorders? Medication CPAP Cognitive Behavioral Therapy Bright Light Therapy Surgery
Do you wish to be contacted about future research projects? No Yes
