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Child & Adult Psychiatrist
Telemedicine
(631) 467-0867
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Telepsychiatry
Comprehensive Psychiatric Evaluations
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Child and Adolescent Psychiatry
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Sleepiness Scale Form
Name
Email
Read the situation for each entry below and select your response.
Sitting and reading
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
Watching television
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
Sitting inactive in a public place, for example, a theatre or a meeting
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
As a passenger in a car for an hour without a break
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
Lying down to rest in the afternoon
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
Sitting and talking to someone
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
Sitting quietly after lunch with you've had no alcohol
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
In a car while stopped in traffic
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
Total all of the entries above and enter the total below.
Total Score
A score of 10 or greater indicates a possible sleep disorder. Send your test results directly to us by clicking below and we will be in touch to discuss your results and set up a consultation for treatment.
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