We won't rest till you do...
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Please complete this questionnaire and return it to the physician who interviews you and your child at the time of the initial evaluation.
In answering the questions are as complete as possible. The more information that is given to more complete Will be the evaluation of your child’s condition.
Use the full space available in the feilds to complete the detailed answers or to add additional information which is relevant.
Select the most appropriate answers in the questionnaire.
DK = Don't Know NA = Not Applicable
The sleep disorder center physicians will go over the answers with you. We look forward to being able to evaluate your child’s problem and to be able to provide therapeutic advice.