Level 3 Sleep Test
Please complete the form below and one of our clinical sleep technicians will contact you with your results and discuss if a level 3 sleep test is required.
Full Name:
*
Address:
*
Phone Number
*
E-mail
*
Confirmation Email
How likely are you to doze off in the following situations?
*
Rows
0 - No Chance
1 - Slight Chance
2 - Moderate Chance
3 - High Chance
Sitting and reading
Watching Television
Sitting inactive in a public space
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
As a passenger in a car for an hour or more
In a car, while stopped for a few minutes in traffic
Submit
Should be Empty: