Sleep Screening Questionnaire

Fields marked with an * are required
HOW LIKELY ARE YOU TO DOZE OFF OR FALL ASLEEP IN THE FOLLOWING SITUATIONS, IN CONTRAST TO FEELING TIRED?
0 = I would never doze
1 = Ihave a slight chance of dozing
2 = 1 have a moderate chance of dozing
3 =] have a high chance of dozing
Situation
Chance of Dozing