9452 9999

Please fill in the following questionnaire by filling in a number in the box by each situation.

In each situation, please try and estimate the chance of you dozing.


 

 

1. Sitting reading a book.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

2. Watching television.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

3. Sitting inactive in a public place eg in a meeting.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

4. Lying down to rest in the afternoon.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

5. Sitting talking to someone.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

6. Sitting quietly after a lunch without alcohol.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

7. In a car stopped in traffic or at lights.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

8. In a car stopped as a passenger for an hour.

Would NEVER doze.

SLIGHT chance of dozing

MODERATE chance of dozing

HIGH chance of dozing

 

SURGERY HOURS

Monday:8.30am - 7.00pm
Tuesday:9.00am to 5.00pm
Wednesday:8.30am to 7.00pm
Thursday:9.00am to 5.00pm
Friday:8.30am to 7.00pm
Sat:9.00am to 11.30am
Sun:9.00am to 11.30am

CONTACT US

Park Medical Group
Unit 2, 779 Albany Highway
East Victoria Park WA 6101
Phone:9452 9999
Fax: 9470 5253

REMINDER SYSTEM

Because our practice is committed to preventative care, we may send you an occasional reminder regarding health services appropriate to your care. If your contact details change kindly inform on of our receptionist.

AFTER HOURS & EMERGENCY

Please phone Perth After Hours Medical Service 1300 000 362 or present yourself to your nearest Emergency Hospital