This page has a series of forms that help in our thorough evaluation of your sleep disorder. It is most helpful if you have filled out these forms prior to your initial evaluation. Please click on the form, print it, complete the appropriate forms and bring it with you to your initial evaluation at the Sleep Disorders Center of CDS.

Click on the following links to download the appropriate form

ESS The Epworth Sleepiness Scale is a tool to screen for the presence and/or the severity of sleepiness. Please fill this out before your first visit to the clinic.

Patient History This form is an essential tool for our staff to help evaluate and treat your problem in a timely manner. Please fill out this form prior to your first visit.

BDI The Beck Depression Inventory is a screening tool for depression. It has been clearly shown that sleep difficulties and depression are frequently tightly linked. Please fill out this form prior to your first visit.

Sleep History Log 1 This sleep log is designed to help our staff understand what your sleep has been like on a daily basis by having you record specific data about your sleep. This tool is especially helpful for individuals with insomnia. Sleep log 1 is for your first visit (please fill out at least 2 weeks worth prior to your first visit)

Sleep History Log 2 and Sleep log 2 is to be used after you have been evaluated by our staff and given a treatment plan.

Circadian Rhythm Questionnaire This survey helps us to understand what your preferred timing of sleep is and how it might impact your sleep behaviors and daytime function. You might be asked to fill out this form after your first visit.