Help us prepare for your appointment by completing this form in advance.
This form includes two validated tools: the Epworth Sleepiness Scale and the STOP-BANG questionnaire for sleep apnoea risk.
Completing it means your doctor has clinical scores ready before your consultation, so you spend your time on solutions rather than paperwork. Takes about 8 minutes.
ESS total 0-24. Score 10+ suggests excessive daytime sleepiness. Rate your likelihood of dozing in each situation.
STOP-BANG score 0-2 = low risk, 3-4 = intermediate risk, 5-8 = high risk for obstructive sleep apnoea.
Use 24-hour format (e.g. 22:30)
If different from bedtime (e.g. if you read or scroll first)
Your natural wake time or alarm time?
Waking 1-2 hours early consistently is a classic sign of depression - your doctor will explore this
Time of day (e.g. 14:00). Caffeine after 2pm can affect sleep
Some medications (antidepressants, beta-blockers, corticosteroids, stimulants, decongestants) can significantly affect sleep
Previous sleep study results if available.
Anything you would like your doctor to know before your appointment.
Your information is sent securely to your doctor at LoveMyLife. We will not share your details with third parties. By submitting this form, you consent to LoveMyLife contacting you regarding your appointment.