Our Patient Questionnaires

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

Download These Questionnaires to Your Computer

To complete a questionnaire, just click on the title of the questionnaire you're interested in. You will be allowed to download the form to complete in the comfort of your home or office. Complete all questionnaires that you feel may apply to you.

All questionnaires, except the New Patient Questionnaire Packet, have been provided only for your education to help you determine if you should seek medical advice. The New Patient Questionnaire Packet, however, must be downloaded and completed by all new patients before your first appointment. This packet may be completed on your computer and submitted to us via email, or you may print it out to complete and deliver it manually.

The New Patient Questionnaire Packet

This questionnaire is required from all new patients before your first appointment date. Clicking the link will take you to the new digital version of the packet, which can be downloaded and completed entirely on your computer. You will find further instructions on the Download Page.

The Sleep Disorder Screening Questionnaire

Download 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

Download 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

Download 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

Download 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

Download 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.

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