...

Home

      Online Analysis Resources Contact Us
.



 
0 - would never doze
1 - slight chance of dozing
2 - moderate chance of dozing
3 - high chance of dozing
.

Chance of Dozing

Situations:

(select one)

  0 1 2 3
Sitting and reading  
.        
Watching TV
.        
Sitting, inactive in a public place (e.g., a theater or a meeting)
.        
As a passenger in a car for an hour without a break.
.        
Lying down to rest in the afternoon when permitted.
.        
Sitting and talking to someone.
.        
Sitting quietly after lunch without alcohol
.        
In a car, while stopped for a few minutes in traffic
.        
Comments
 
Name:  
Address:
City
State:

Zip:

Phone:
Email:  

     
 
.................................
 

 

Accredited by the
Joint Commission
On Accreditation of
Healthcare Organizations

 

Contact Us

Email Webmaster

Map & Directions





Home | Services | Online Analysis | Sleep Facts | Frequently Asked
Questions | Resources | Contact Us | Email Our Webmaster | Map & Directions

Copyright © 2002 Southern Sleep Technologies.  All Rights Reserved.
Web Design by W4 Designs