Sleep Factor

Name of the patient *

Name of the Doctor *

Contact Number of Patient / Referring Doctor *

Email Address

Date of Birth of Patient *

At What Time You Go To Bed *

Hours

Minutes

At What Time You Get Up ? *

Hours

Minutes

1. How many minutes do you need to fall asleep? *Less Than 20 Minutes21 to 40 Minutes41 to 60 Minutes61 to 90 Minutes (1 hour to 1.30 hours)91 or more minutes (More than 1.30 hours)

Regensburg Insomnia Scale (RIS) - Sleep Depth (Out of 12)

Regensburg Insomnia Scale (RIS) - Sleep Quantity (Out of 12)

Regensburg Insomnia Scale (RIS) - Fearfully Focusing On Insomnia (Out of 8)

Regensburg Insomnia Scale (RIS) - Hypnotics And Day Time Functioning (Out of 8)

Reviews

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