New TMS, Genetic Testing or Sleep Medicine Patients

The following forms can be downloaded to your computer and printed at home. In order for Dr. Saribalas to provide a complete and comprehensive medical opinion it is important that he review all your medical information. Please be prepared to provide this information to our office along with your current medical insurance information.

Patient Information Form

Patient Questionnaire
Bed Partner or Observer Questionnaire

Sleep Diary Form


"I think it is awesome to have an internationally known Sleep Psychiatrist locally. " - Jean C.

"Dr. Saribalas is brilliant! He provides amazing care, and is always able to answer my questions." - Jason P.

"The therapy is worth it. I did not think I would feel so refreshed ." - Evan G.

"I thought snoring was just something I had to deal with. Since therapy, I am now able to get a good nights sleep."
-Brett B.

"I cannot believe we did not have this evaluated a long time ago ." - Stacee M.

We offer free Wi-Fi and bottled water in our facility.
Saribalas Clinic
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Tel: 614.532.5232
Affiliated with Mt. Carmel Health System and Ohio Health.
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