SYMPTOMS

SAS preferred member.. Free sign up to access brand specific sales and newsletter.

Do you have any of these symptoms?

Epworth Sleep Test

Please fill in the questionnaire to help assess your risk of Sleep Apnea.

Name:

Email:

Telephone:

0 = No chance of dozing
1 = Slight chance
2 = Moderate chance
3 = High chance

Sitting and Reading:

0 1 2 3

Watching TV:

0 1 2 3

Sitting inactive in a public place:

0 1 2 3

A passenger in a car for 1 hour:

0 1 2 3

Lying down in the afternoon:

0 1 2 3

Sitting and Talking:

0 1 2 3

Sitting quietly after lunch:

0 1 2 3

Stopped in traffic for a few minutes:

0 1 2 3

Message / Comments: