Sleep Disorders Center
at Trinitas Hospital  908-994-8694


Contact Form



 
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Additional Information
Initially, we prefer that you call us to discuss your problem so we can help determine if you need to come in directly or if you need to get a referral from your primary care physician.

The Trinitas Hospital Sleep Disorders Center's phone number is
908-994-8694.

We may ask you for your email address so that we can send you a packet of materials you can print and fill out in advance of your appointment. This packet may include a Sleep Diary, our initial Intake Form and a list of things you may want (or need) to bring with you.

If you cannot provide us with an email address, or cannot print Adobe Acrobat .pdf forms, we can mail the materials to you if you choose.




 
Local Help
Across the US, there are accredited sleep centers where you can seek help for your sleep-related problems. If you would like to find a sleep center in your area, go to www.aasmnet.org. You may also wish to speak to your primary care physician.

 
 


If you feel you may have a sleep disorder and would like us to contact you with more information, please complete the brief form below.

Required Information*

First Name*

Last Name*

Email Address*

Main Phone*

Main Phone is:*
Home Number Work Number
Friend Or Relative's Number

Optional Information

 

Address

 

City

 

   State
   
 

Zip

 

Home Phone

 

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Preferred method to contact you

 

Issue/Problem Of Interest/Concern
(check all that apply)
Need An Appointment
Snoring
Insomnia
Narcolepsy
Sleep Apnea
Restless Leg Syndrome
Cataplexy
Sleepwalking
Bedwetting
Gastroesophageal Reflux
Night Terrors
Other (please explain in
    Comments)
Not Applicable

I am (check one)
a potential patient
seeking info for someone else
a physician**
an Allied health professional
a Governmental/social services
    rep
a Media rep
Other (please explain below)

** If you're a physician, click here for our Referral Form. Please fill it out and fax it back to us with your instructions.


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210 Williamson St., Elizabeth, NJ 07202

908-994-8694

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