• The Epworth Sleepiness Scale

  • How likely are you to doze off or fall asleep in the following situations? This refers to your usual way of life in recent times. Use the following scale and select the most appropriate number for each situation. 

    0 = Would never doze
    1 = Slight chance of dozing
    2 = Moderate chance of dozing
    3 = High Chance of dozing

  • Please select the most appropriate number for each situation.
    Rows

  • Scale:

    1-6= Getting enough sleep to pushing limits of proper sleep habits
    7-8= Average score; consider placing more emphasis on better sleep habits
    9 or above= Consult your family physician

  • Birthday:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: