Patient Forms

A registration form must be completed by all patients. Please download, print and fill out the Patient Registration Form. Please bring the completed form with you to your appointment. The Notice of Privacy Practices (HIPAA) is for you to keep.

Adult Intake Packet – English   Adult Intake Packet – Spanish

If you are coming in for your first visit with your office, please also complete this pack and bring them it with you to your appointment.

Pediatric Intake Packet – English   Pediatric Intake Packet – Spanish

If you are coming in for your child’s first visit, please complete the following and bring them with you to your appointment.

CPAP Questionnaire – English   CPAP Questionnaire – Spanish

If you are coming in for a routine follow-up appointment and use a CPAP, BIPAP, AVAPS, or ASV device, please complete the following and bring it with you to your appointment.

Two Week Sleep Dairy - English   Two Week Sleep Dairy - Spanish

If you are coming in for a routine follow-up appointment and use a CPAP, BIPAP, AVAPS, or ASV device, please complete the following and bring it with you to your appointment.

Patient Policies

For questions regarding office policies for canceling appointments or prescription refills.

All forms are in PDF format, you will need to

download and install Adobe Acrobat Reader to View.

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SleepMS | Dr. Alexander Clerk's Office

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O'Connor Health Center 1
455 O'Connor Drive, Suite 110 
San Jose, CA 95128

Contact Us

• Office: (408) 295-4532

• Fax: (408) 295-4738
• E-mail: admin@sleepmsinc.com

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