Transcription of Insomnia Symptom Questionnaire - uofthenet.org
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Insomnia Symptom Questionnaire - uofthenet.org
Insomnia Symptom QuestionnaireName:date:Instructions: If you have experienced any sleep symptoms during the past month please circle the appropriate number to let us know how your sleep is affecting your daily the past month did you not knowRarelyless than once per weekSometimes1-2 times per weekFrequently3-4 times per weekAlways5-7 times per weekHow long has the Symptom lasted?(# of weeks, months or years)1. Difficulty falling asleep?0123452. Difficulty staying asleep?0123453. Frequent awakenings from sleep?0123454. Feeling that your sleep is not sound?0123455. Feeling that your sleep is unrefreshing?
Insomnia Symptom Questionnaire Name: date: Instructions: If you have experienced any sleep symptoms during the past month please circle the appropriate number to let us know how your sleep is affecting your daily life. During the past month did you have... Never Do not know
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