Patient Intake Questionnaire

Do you wake up tired after sleeping? Yes/No. Do you fall asleep easily watching TV? Yes/No. Do you fall asleep at work? Yes/No. Have you fallen asleep at the wheel? Yes/No. Do you have nightmares? Yes/No. Do you feel confused upon awakening Yes/No. Do you grind your teeth at night? Yes/No. Do you kick/ twitch your legs at night? Yes/No ................
................