The following assessment parts are click-based questions designed to collect health and medical information to assist both your GP and Sleep & Respiratory Physician reporting on your sleep test.

Part 1) List Symptoms and Medical Conditions

Part 2) Complete two sleep health industry-based questionnaires.   

The information provided in this form is reviewed by an Australian Sleep & Respiratory Physician as part of your sleep health assessment.  This information assists the specialist when analyzing your night of sleep test data and formulating your sleep report. 

 

The following two questionnaires are industry-standard sleep health questionnaires designed to assess symptoms and risk factors for obstructive sleep apnea and daytime sleepiness.

Reviewed by an Australian Sleep & Respiratory Physician these risk scores are included in your sleep test report and used by the specialist when analyzing your night of sleep test data and formulating your sleep report. 

To help you complete each questionnaire:

Let's start by calculating your Body Mass Index Score (BMI).

 

The ESS questionnaire assesses your level of daytime sleepiness based on how likely you are to doze off or fall asleep in various situations.

 

Select the number score that best describes your likelihood of dozing off or falling asleep. 

0 = no chance of falling asleep/dozing

1 = mild chance of falling asleep/dozing

2 = moderate chance of falling asleep/dozing

3 = severe chance of falling asleep/dozing

NEXT STEPS

Click the submit button at the end of this form.

A PDF copy of your sleep health assessment today will be sent to your provided email.

Please make an appointment with your GP and take this form with you.

Your GP is welcome to sign this form as a way of onward referral for a home sleep test to investigate and test for Sleep Apnea.

Please check your email to retrieve your completed form.