(In addition to this list, please download, complete, and print the form below.)

1. Driver's License

2. Form of Payment (Cash or Credit Card)

3. Medication List

4. List of Surgeries and/or Medical Conditions

5. The name of your Primary Care Doctor

6. If you are Diabetic: an A1C test that is less than 90 days old

7. If you are using a CPAP/BiPAP or have been diagnosed with Obstructive Sleep Apnea: CPAP/BiPap:  Initial diagnosis requires a 30-day usage report at minimum, showing the machine is used at least 70% of the time for 4+ hours per night.  Following initial certification, a 1-year report is needed also showing 70% usage for 4+ hours per night. Inspire implanted stimulators used to treat sleep apnea also requires a report showing usage of at least 70% and 4+ hours per night. 

8. If you have a history of: Heart Attack, Cardiac Bypass Surgery/CABG, Cardia Stent, A-Fib (Atrial Fibrillation), or Ventricular Arrhythmias you will need a Cardiac Stress Test or Echocardiogram that is less than 2 years old. Please bring in a printed copy of the report. There are some other less common heart conditions that may require further testing so please call us with any questions.

9. If you have COPD: you may be required to have a Medical Clearance letter from your Pulmonologist depending on the severity of your case. 

10. If you suffer from a Mental Disorder you may be required to provide a medical clearance letter from your doctor stating your diagnosis/disorder. Please be aware that some mental disorders and some medications used to treat mental disorders (benzodiazepines, hypnotics, neuroleptics, tricyclic antidepressants) will result in Disqualification. 

11. If you have or have had a Substance Abuse problem: you may be required to provide a medical clearance letter from a Substance Abuse Professional (SAP) and/or letter of completion regarding completed drug/alcohol/substance treatment program. Certain medications used to help treated substance abuse may result in a disqualification (Methadone, Suboxone, Naltrexone, Antabuse).

12. Any other questions regarding a medical condition or what you may need to bring, please feel free to call us at 262-930-1776.