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Mnuero

079 115 2508 info@mneuro.co.za 97 Davidson Street, George Central
Free Sleep Assessment Questionnaire

Could poor sleep be affecting your health and daily life?

This questionnaire helps visitors identify symptoms that may require further discussion with a healthcare professional. It is not a diagnostic test and does not replace a sleep study, medical consultation or emergency assessment.

Answer the questions as accurately as possible. Choose Yes, No or Unsure where applicable.
Before you begin

A general screening and enquiry tool.

The questions cover night-time symptoms, daytime symptoms, general risk information and your normal sleep routine.

Your answers do not provide a diagnosis

Persistent poor sleep, unusual night-time events, breathing concerns or daytime tiredness should be discussed with a qualified healthcare professional.

Your details

These details are used only when you choose to submit your answers to MNeuro.

Section 1: Night-Time Symptoms

Answer options: Yes | No | Unsure

Section 2: Daytime Symptoms

Answer options: Yes | No | Unsure

Section 3: General Risk Information

Answer options: Yes | No | Unsure

Section 4: Your Sleep Routine

Complete the fields that apply to your normal routine.

Main concern

Would You Like to Submit Your Answers?

Choose an option

Assessment guidance

This questionnaire is an awareness and enquiry tool. It does not diagnose sleep apnea or another sleep disorder.

Questionnaire Licensing Note

The exact Epworth Sleepiness Scale and STOP-Bang questionnaire should not be copied or branded as original practice tools without confirming the relevant permissions and licensing terms. The custom questionnaire on this page is an awareness and enquiry tool and must not be represented as either licensed instrument.

Important safety notice

Do not drive when dangerously sleepy. Seek urgent help if you experience severe breathing difficulty or another medical emergency.

Appointments & Enquiries

Ready to arrange your appointment?

Contact the practice directly or complete the secure appointment form on the Contact page. A referral will be required from your private healthcare physician or a referring medical specialist.

Visit97 Davidson Street, George Central
Operating Hours08:00 to 16:00, Monday to Friday
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Contact or Book

Contact the practice or complete our appointment form.

Visit the Contact page to send a general enquiry, call or email the practice, or complete the secure appointment form online.

This website does not provide a diagnosis and is not monitored as an emergency service.