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K. Johns MedicalMedical & Behavioral Health

Screening · About 3 minutes

Insomnia and sleep screening

Please rate the severity of your sleep difficulties over the last 2 weeks.

About you

Please give at least a telephone number or an email address so the office can reach you.

Sleep difficulty
Difficulty falling asleep*
Difficulty staying asleep*
Waking up too early*
Satisfaction and impact
How satisfied or dissatisfied are you with your current sleep pattern?*
How noticeable to others do you think your sleep problem is?*
How worried or distressed are you about your current sleep problem?*
How much does your sleep problem interfere with your daily functioning?*
Habits
Do you use screens in bed within an hour of trying to sleep?

Your responses are scored automatically when you submit. A score is not a diagnosis and is always reviewed by a clinician.

Submitting sends your answers directly to K. Johns Medical over an encrypted connection and creates a PDF for your clinician. It does not book an appointment and is not monitored in real time. For an urgent concern, call the office. In an emergency, call 911 or call or text 988.

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