Jiva Health Inc.
2182 East St,
Concord, CA 94520
Phone: (925) 685-4224 Fax: (925) 685-6997

REM Logo

REM Sleep Diagnostics Inc.
2601 Nut Tree Road, Suite C,
Vacaville, CA 95687
Phone: (707) 469-8400 Fax: (707) 469-8469

Contra Costa Sleep Center
2121 Ygnacio Valley Road E101,
Walnut Creek, CA 94598
Phone: (925) 944-0166 Fax: (925) 848-3999

Patient Assessment Questionnaire

Home Sleep Apnea Test Screening

Category 1

Category 2

Category 3

Home Sleep Apnea Test Screening
Home Sleep Apnea Test Instructions

I have received one of the following Home Sleep Apnea Testing devices from Jiva Health.
I will carefully follow the instructions for the device received matching the picture below.

SleepImage Mobile App

You will need the Patient ID provided by Jiva Health

REMEMBER: Patient support can be reached at 800-818-4564

Failure to return the device after 48 hours serves as authorization to bill the responsible party the amount of $2000 for replacement of the device. I also agree to pay $25 per day beyond the return date and for all fees and costs associated with collecting this billable charge, including collection agency and attorney fees. These fees will be added to the purchase price.

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