Epworth Sleepiness Scale Epworth Your Name * Date of Birth * Your GP * choose from the list Dr Walls Dr Boyd Dr Calvert Dr MacSorley Dr Carswell Dr Duffy Dr Dickie Dr Mayson Dr Gilhespy Dr Mears How likely are you to doze off or fall asleep during the following situations? 1. Sitting and reading * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance 2. Watching TV * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance 3. Sitting, inactive in a public place * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance 4. As a passenger in a car for an hour without a break * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance 5. Lying down to rest in the afternoon when circumstances permit * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance 6. Sitting and talking to someone * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance 7. Sitting quietly after a lunch without alcohol * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance 8. In a car, while stopped for a few minutes in the traffic * choose from the list 0 - would never doze off 1 - slight chance 2 - moderate chance 3 - high chance reCAPTCHA Submit Start Over If you are human, leave this field blank.
