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How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. By taking this test, you not only help determine your sleep scale, you also help us determine what services to bring to the community. Your anonymous answers are used to better understand the health needs of the population of Arkansas and deliver services where they are needed.

Click HERE to visit the BAPTIST HEALTH Sleep Disorders Center

(Note: ** indicates a field which requires information to complete the survey)

Zip Code **:
City:
State:
Age**:

Answer each question according to the following scale:
0) Never/Very Rarely 1) Rarely 2) Occasionally
3) Usually 4) Always

Sitting and reading?

Watching TV?

Sitting, inactive in public place (e.g., theater or meeting)?

As a passenger in a car for an hour without a break?

Lying down to in the afternoon when circumstances permit?

Sitting and talking to someone?

Sitting quietly after lunch without alcohol?

In a car, while stopped for a few minutes in traffic?

   

Baptist Health
Little Rock - 501.202.2000 North Little Rock - 501.202.3000 Arkadelphia - 870.245.2622 Heber Springs - 501.206.3000 All Arknasas Locations - 1-800-BAPTIST Little Rock Maps North Little Rock Maps Arkadelphia Maps Heber Springs Maps

For Direct Physician Referral & Appointments

501-227-8478 or 1-888-BAPTIST(227-8478)

BAPTIST HEALTH is the largest not-for-profit healthcare organization in Arkansas.

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