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APPENDIX 3.4: Sleep History Questionnaire Name Age Race/Ethnicity Date Name of Primary Physician: Name of Referring Physician (if not your primary physician): Briefly describe the problem(s) you are
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Begin by understanding the purpose of the form. If the question asks whether the information being provided is for your primary residence or primary use, you need to determine if the answer is "Yes" or "No."
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Individuals who are using a property for a specific purpose that is not their primary one, such as using a business property for personal reasons or vice versa, will also need to fill out this section accordingly.
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