Secure File Upload

Use this form to securely send us files or pictures.

(e.g. "Alice," "front desk," or "my clinician")
(e.g. "insurance cards," "referral," or "old sleep studies")
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Contact form for The Center For Sleep and Wake Disorders

Please Select the Subject/Issue
Full Name of Patient:
Date of Birth:
Your E-mail:
Your E-mail again:
Please describe your issue here:

In order to comply with Federal regulations regarding the protection of electronic protected health information (ePHI), the Center for Sleep & Wake Disorders requires that all electronic communication with patients be via our secure patient portal unless this email authorization form is signed ahead of time. We can no longer use email to communicate with patients without this document on file. If you have not done so already, please complete this email authorization form so that we may communicate with you via email. Thank you.

The front desk staff answers phone calls between 9:00am and 12 noon, and between 2:00 pm and 4:00 pm. Callers for the front desk outside those hours can leave voicemail messages, which are picked up throughout the day.

*If this is a life-threatening emergency, please do not use this form. Please call 911.*