EPWORTH SLEEP SCALE
This is an informational tool to help assess your sleepiness level. It is a well-known screening tool in sleep medicine, and can be used as a starting point for a conversation with your doctor.
How likely are you to doze off or fall asleep in the following situations?

Situation Chance of dozing
Sitting and reading
Watching TV
Sitting inactive in a public place (e.g. a theater or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic
Total Epworth Score:
Interpretation:
First Name:      Last Name:

Date of Birth: (MM/DD/YYYY)   

Height: ft      inches      Weight lb     

What type of insurance do you have?      

Insurance company name:     

Area code:      Phone:      Email:

How did you hear about Bay Sleep Clinic?