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Patient Questionnaires

Our Patient Questionnaires

To assist you in determining whether or not you may suffer from one or more sleep disorders, and to help us learn more about your particular difficulties, we have provided a few short questionnaires that should help you reach a decision about seeking medical treatment.

Submit Online or Download to Your Computer

To complete a questionnaire online, and submit it to our office from the comfort of your computer, just click on the title of the questionnaire you’re interested in. You will be taken to the online form to fill in your information. Complete all questionnaires that you feel may apply to you.

If you would prefer to download the questionnaire in PDF format and mail, fax, or deliver it to us upon completion, simply click the PDF icon to the right of each questionnaire description.

The New Patient Questionnaire Packet

The New Patient Questionnaire PDF

This questionnaire is required from all new patients before your first appointment date. It cannot be completed nor submitted online. Please download the PDF and complete the forms in the comfort of your home, then fax, email, or deliver them to our office to schedule your evaluation appointment.

The Sleep Disorder Screening Questionnaire

The Sleep Disorders Screening Questionnaire PDF

Choose this questionnaire if you have difficulty falling and staying asleep, snore or stop breathing during, or has lack energy, feel fatigued during the daytime.

The Epworth Sleepiness Scale Questionnaire

The Epworth Sleepiness Scale PDF

Choose this questionnaire if you lack energy or feel fatigued during the daytime. An abnormal score indicates pathologic sleepiness and warrants further evaluation.

The International Restless Limb Syndrome (IRLS) Rating Scale

The Restless Limb Syndrome PDF

Choose this questionnaire if you think you might have Restless Limb Syndrome (RLS) a disorder manifest by an irresistible urge to move, often associated with unpleasant sensations, occurring primarily when you are at rest (sitting or lying down), more prevalent during the evening hours and relieved (temporarily) with movement of the affected body part.

The Obstructive Sleep Apnea Questionnaire

The Obstructive Sleep Apnea PDF

Choose this questionnaire if you snore, awaken from choking, gasping or grunting, or have been told you hold your breath during sleep. This simple 5 question quiz will help you determine if you need a professional consultation.

The Insomnia Severity Index Questionnaire

The Insomnia Severity Index PDF

Choose this questionnaire if you have difficulty falling and staying asleep, wake up during the night and have difficulty falling back asleep, lack energy or feel fatigued during the daytime.

The Beck Depression Inventory

Download the Beck Depression Inventory PDF

Download this questionnaire, print it out and answer all questions. Then bring it with you on your next visit to our office.

The Beck Anxiety Inventory

The Beck Anxiety Inventory PDF

Download this questionnaire, print it out and answer all questions. Then bring it with you on your next visit to our office.

Download Free Adobe Reader

Download the free Adobe Reader

Download a free copy of the latest version of Adobe Reader for opening and viewing all PDFs found on this site.