Online Insomnia & Sleep Problem Questionnaire

Use Our Free Insomnia & Sleep Problem Questionnaire To Find Out If You Are Likely To Benefit From Treatment...

Our Online Insomnia & Sleep Problem Questionnaire is commonly used by Doctors, Psychologists and Therapists to help understand if you are likely to benefit from treatment of insomnia symptoms.

Insomnia Questionnaire

Question 1 of 7

Please select the answer that best describes the severity of your insomnia problems over the past 2 weeks.

Having difficulty falling asleep

Question 2 of 7

Please select the answer that best describes the severity of your insomnia problems over the past 2 weeks.

Having difficulty staying asleep

Question 3 of 7

Please select the answer that best describes the severity of your insomnia problems over the past 2 weeks.

Problems waking up too early

Question 4 of 7

Please select the answer that best describes how satisfied or dissatisfied you are with your current sleep pattern?

Question 5 of 7

Please select how noticeable to others you think your sleep problem is in terms of impairing the quality of your life?

Question 6 of 7

Please select how worried or distressed you are about your current sleep problem?

Question 7 of 7

Please select the extent you consider your sleep problem to interfere with your daily functioning (i.e. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory etc) currently.

Thank you for taking our Insomnia Questionnaire.  Please enter your First Name and Email Address below so we can email you a copy of your results report.  You can also add your phone number if you would like us to call you to discuss your questionnaire results or having Therapy sessions with us.

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At the end of the questionnaire we’ll show you your results and email a personalised report of the results to you.  As a private healthcare clinic, your confidentiality and privacy are a key priority of ours.  In line with UK data laws we will never disclose, share or sell ANY data we hold to any other party.