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Home
Clinic
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Telehealth Consultations
Sleep Studies
Dr David Cunnington
FAQs
Questionnaires & forms
Registration form
Prescription requests
Attend Appointment
Telehealth appointment
In-clinic appointment
FAQs
Questionnaires & forms
Learn about sleep
Contact
Ph: 03 8609 0308
Hypersomnia Severity Index
Full Name
(Required)
Email
(Required)
For these next few questions, please consider your SLEEP IN THE PAST MONTH. To what extent do you think that you:
Sleep too much at night?
Not at All
A Little
Somewhat
A Lot
Very Much
Have difficulty waking up in the morning or from naps?
Not at All
A Little
Somewhat
A Lot
Very Much
Sleep during the day?
Not at All
A Little
Somewhat
A Lot
Very Much
Feel sleepy during the daytime?
Not at All
A Little
Somewhat
A Lot
Very Much
How SATISFIED/dissatisfied are you with your current sleep pattern?
Very satisfied
Satisfied
Moderately satisfied
Dissatified
Very dissatisfied
To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g., daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.)?
Not at All
A Little
Somewhat
A Lot
Very Much
How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life?
Not at all Noticeable
Barely
Somewhat
Much
Very much Noticeable
How WORRIED/DISTRESSED are you about your current sleep problem?
Not at All
A Little
Somewhat
A Lot
Very Much
Do you ever have “sleep attacks,” defined as unintended sleep in inappropriate situations?
Not at All
A Little
Somewhat
A Lot
Very Much
Total Score