Epworth Sleepiness Questionnaire Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *What are the chances of you falling asleep during the daytime when watching TV?No ChanceSlight ChanceMedium ChanceHigh ChanceWhat are the chances of you falling asleep during the daytime when sitting inactive in a public place (e.g. waiting area, cinema or meeting etc)No ChanceSlight ChanceMedium ChanceHigh ChanceWhat are the chances of you falling asleep during the daytime when you're a passenger in the car for an hour without a breakNo ChanceSlight ChanceMedium ChanceHigh ChanceWhat are the chances of you falling asleep during the daytime when you're lying down to rest in the afternoon when circumstances permitNo ChanceSlight ChanceMedium ChanceHigh ChanceWhat are the chances of you falling asleep during the daytime when you're sitting and talking to someoneNo ChanceSlight ChanceMedium ChanceHigh ChanceWhat are the chances of you falling asleep during the daytime when sitting quietly after lunch without alcoholNo ChanceSlight ChanceMedium ChanceHigh ChanceWhat are the chances of you falling asleep during the daytime in a car while stopped for a few minutes in the trafficNo ChanceSlight ChanceMedium ChanceHigh Chancewhat are the chances of you falling asleep when sitting and readingNo ChanceSlight ChanceMedium ChanceHigh ChanceSubmit
