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Sleep Medicine Patient Forms

Please download the new or follow-up patient form below and either:

  • Bring to your in-person scheduled appointment or
  • Send it back to us at least two days prior to your virtual appointment.

If you need help or have any questions please contact 413-794-5600

Download and Complete Patient Forms

Please download and complete the form applicable to your situation: 

You may also download an editable Microsoft Word document:

Send the completed form to us using one of the following options:

  • Fax to 413-787-5713
  • Email to nlw4@baystatehealth.org (This is not HIPAA secure. Do not send other medical questions to this email.)
  • Send back through the MyBaystate patient portal (instructions below)
  • Mail at least two weeks before your appointment: 

Neurodiagnostic and Sleep Center
Baystate Medical Center
759 Chestnut St, Wesson Ground
Springfield, MA 01199

MyBaystate Patient Portal

You may also sent your form to us securely on the MyBaystate patient portal:

  1. Log in to the MyBaystate portal.
  2. Create a new message addressed to Karin G. Johnson, Sleep Medicine (or to your provider if known).
  3. Attach a picture of your completed form to the message. 
  4. Press "Send."