Toronto Private Hospital Sleep Study Referral

Referrer information


If this referral is being completed by a registrar or intern, details of the referring consultant must be provided below

Patient Information

Funding source

Referral Information

GP direct referral questionnaires

Please complete the two questionnaires below to ensure the patient has a high probability for significant symptomatic obstructive sleep apnoea.

Epworth Sleepiness Scale - Patient self-report tool

Please circle only one number per scenario: (0 = never, 1 = slightly, 2 = moderately, 3 = highly).

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times (last few months). Even if you have not done some of these things recently, try to work out how they would have affected you.

Total must be 8 or higher to be eligible for direct referral for initial sleep study, followed by Sleep Physician consultation. For patients with values <  8, they will be referred for a Sleep Physician consultation first.


OSA50 - Patient self-report tool

Please circle yes or no.

Total must be 5 or higher to be eligible for direct referral for initial sleep study, followed by Sleep Physician consultation. For patients with values 5, they will be referred for a Sleep Physician consultation first.



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Submission of an online referral does not does not automatically constitute acceptance of the referral. We will contact your patient, and you will be advised of the outcome.

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