Snoring Laser Care Treatment In North Mackay QLD

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Epworth Sleepiness Scale

Do you snore?

Please tick how likely you are to doze off or fall asleep in the following situations:

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

Sitting and Reading

Watching television

Sitting inactive in a public place

Passenger in a car

Lying down to rest in afternoon

Sitting & Talking to someone

Sitting quietly after lunch without alcohol

Driving a car, while stopped for a few minutes in traffic

Questions

Snoring

Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Yes

Tired

Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Yes

Observed

Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

Yes

Pressure

Do you have or are being treated for High Blood Pressure?

Yes

Body Mass Index more than 32 kg/m2?

Calculate

Yes

Age older than 50?

Yes

Neck size large ? (Measured around Adams apple)

For male, is your shirt collar 17 inches / 43cm or larger?
For female, is your shirt collar 16 inches / 41cm or larger?

Yes

Smoker?

Yes

Alcohol consumption

For males, more than drink more than 20 drinks per week?
For females, more than 10 drinks per week?

Yes

Gender

Male

Female

To receive a full copy of your results of the survey, please complete the details and we send them to you immediately after completing the survey.

First Name *

Last Name *

Email *

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Mobile Phone *

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