Date Of Birth
Notes, Comments, or Questions
Have you had or do you currently have any of the following?
Chance of Dozing
in the following situations. Base your answers on your usual way of life in recent times. Even if you have not been in some of these situations recently, try to work out how they would have affected you.
Sitting and reading:
Sitting inactive in a public place:
As a passenger in a car for an hour:
Lying down in the afternoon:
Sitting and talking to someone:
Sitting quietly after a lunch without alcohol:
In a car, while stopped for a few minutes in traffic: