Order Services Online

Order a test or set-up for your patient today.

How to order online:

Submit your request online here.
We will contact you if additional information is needed. You can also fax information to (877) 855-6227 or email orders@sleepdr.com
We will contact your patient to schedule once we have all of the information.
We will verify your patient’s insurance benefits and request authorization, if needed, before providing service.

Order Services Online

Doctor's Name*
Doctor's Office City
Name of person making this request
Your role*
Phone Number*
Email Address*
Fax Number*
Please provide as much patient information as possible so that we can process your request immediately. We will contact you to obtain any missing information.
Patient's First Name*
Patient's Last Name
Patient's Phone Number*
Insurance Name*
What service are you requesting?*
Additional info, if needed

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