Sleep Questionnaire


The button below will take you to a form that is a little more comprehensive if you want to fill that one out.

Name *
Sleep Problems
Do you snore loudly or stop breathing while you sleep? *
Have you had a sleep study performed? *
Do you use a CPAP machine? *
Sleepiness Questions:
Do you feel well rested in the morning? *
Do you feel well rested after a nap? *
Insomnia Questions:
Do you ever feel so wired at night that it is difficult to fall asleep? *
Do you currently take, or have you tried, any of the following sleep aids to fall asleep? *
Check all that apply.
Does feeling the need to move your feet or legs at night keep you awake or have you been diagnosed with Restless Legs Syndrome? *
Do you have disturbing dreams at night? *