QuestionnaireHome » Questionnaire Step 1 of 333%Are you often tired?*YesNoDo you snore?*YesNoHave you ever woken up gasping for breath?*YesNoHas anyone ever witnessed you stop breathing when asleep?*YesNoDo you wake frequently throughout the night?*YesNoDo you visit the bathroom more than once at night?*YesNoDo you suffer from morning headaches?*YesNoDo you wake up feeling unrefreshed?*YesNoHave you ever fallen asleep at an inappropriate time?*YesNoDo you suffer from poor memory or concentration?*YesNoDo you have reduced libido?*YesNoHave you ever had a accident or ‘near miss’ because of tiredness?*YesNoAre moody or depressed?*YesNoDo you have Diabetes?*YesNoDo you have high blood pressure?*YesNoDo you have atrial fibrillation or other heart disease?*YesNoAre you a current smoker?*YesNoAre you overweight?*YesNoAre you Male?*YesNoAre you over 50 years old?*YesNoThank You for completing the QuizYour score is:{quiz_score}Out of 20Please enter your details below to have the results emailed to you.Name*Email* Phone Number **Suburb* This iframe contains the logic required to handle Ajax powered Gravity Forms. Contact UsGot a question? We’d love to hear from you. Send us a message and we’ll respond as soon as possible. Name*Email* Ask Us This iframe contains the logic required to handle Ajax powered Gravity Forms.
