Please rate the following symptomatic
improvements from 1-5
1 = no improvement, 5 = significant improvement
What difficulties have you
experienced with your therapy?
Please rate the following
regarding your Nightshift therapy:
Note: This is to be completed by the patient, about themselves.
The following questions ask about how you have been feeling over the last two weeks. Please mark the box which is closest to how you have been feeling.
For each question, please rate the current severity of your sleep
problem by selecting the most appropriate response from the drop down list.