How likely are you to doze off or fall asleep in the following situations:

Sitting and Reading *

0 - Would never doze

1 - Slight chance of dozing

2 - Moderate chance of dozing

3 - High chance of dozing

How likely are you to doze off or fall asleep in the following situations:

Watching TV *

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

How likely are you to doze off or fall asleep in the following situations:

Sitting, inactive in a public place (e.g. a theatre or a meeting) *

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

How likely are you to doze off or fall asleep in the following situations:

As a passenger in a car for an hour without a break *

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

How likely are you to doze off or fall asleep in the following situations:

Lying down to rest in the afternoon when circumstances permit *

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

How likely are you to doze off or fall asleep in the following situations:

Sitting and talking to someone *

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

How likely are you to doze off or fall asleep in the following situations:

Sitting quietly after a lunch without alcohol *

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

How likely are you to doze off or fall asleep in the following situations:

In a car, while stopped for a few minutes in the traffic *

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

Great! Fill out the information below and our team will be in touch with your results and to answer any questions.

Full Name

Phone *

Email *

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