Patient Forms

Sleep Center Charlotte NC

Thank you for selecting Gingras Sleep Medicine for infant, pediatric, and adult sleep disorder evaluation and sleep medicine treatment. To make an appointment at our Charlotte, North Carolina sleep medicine office, please call (704) 944-0562 or request an appointment online.

Once you have made your initial appointment, please fill out the interactive forms below. There are 3 forms for adults and 3 forms for children. Please fill out all three forms: Patient Registration, Sleep Questionnaire and Mandatory Forms. They will come to our office for Dr. Gingras to review prior to your visit. It is important that these forms are filled in prior to your scheduled appointment with Dr. Gingras.

Interactive Adult:

• Patient Registration – Adult
• Sleep Questionnaire – Adult
• Mandatory Forms 

Interactive Child:

• Patient Registration – Pediatric
• Sleep Questionnaire – Pediatric
• Mandatory Forms 

If you or your child is being evaluated for Insomnia (difficulty falling or staying asleep) please print the SLEEP DIARY and complete it for at least 2 weeks, preferably 3 weeks.

• Sleep Diary

Please complete this form telling what what members  we able able to share medical information with.

• Members Permission Form

Downloadable:

• Patient Registration – Adult
• Patient Registration – Pediatric
• Sleep Questionnaire – Adult
• Sleep Questionnaire – Pediatric
• Sleep Diary

 Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.