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25 Molly Morgan Drive, East Maitland NSW 2323

(02) 4018 7506

Hunter Respiratory
and Sleep Centre

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Epworth Sleepiness Scale

First Name

Last Name

Email

Phone

Date of Birth (DD/MM/YYYY)

How likely are you to doze off (fall asleep) in the following situations?

Use the following scale to choose the most appropriate answer:

Use the following scale to choose the most appropriate answer:

0 - No chance

1 - Slight chance

2 - Moderate chance

3 - High chance

Thanks for submitting!

25 Molly Morgan Drive, East Maitland NSW 2323

Tel: 02 4018 7506

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