Sleep Study Intake Questionnaire
Sleep study intake covering sleep habits, snoring, breathing pauses, daytime sleepiness and current medications before a scheduled overnight sleep assessment.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 14 questions, 2 pages, 1 conditional rules.
- Questions
- 14
- Pages
- 2
- Layouts
- classic · card
- Time to complete
- ≈ 6 min
- Conditional rules
- 1
Searches this template answers
- sleep study intake form
- sleep questionnaire form
- sleep clinic intake form
- sleep assessment form online
- insomnia intake form
- sleep apnea questionnaire form
Also filed under
Live preview and test console
This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.
Page 1 of 2 — Sleep history
Every question on this page is currently visible.
Compliance checklist
- Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
- Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
- Medical disclaimer present — passingThis form does not provide medical advice, diagnosis or treatment. Information you share here is not a substitute for care from a qualified clinician. In an emergency, contact your local emergency service immediately.
- Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.
What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.
Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.
Who this template is for
Sleep Study Intake Questionnaire is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 14 questions across 2 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 12 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It collects a verified email address so replies and confirmations land.
- It captures a phone number for urgent follow-up.
- It pins the request to a specific date.
- Conditional logic hides 1 question until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Sleep Study Intake Questionnaire lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 1 conditional rule ship with it.
- Features advanced show logic: if “Do you fall asleep unintentionally during the day?” is Yes, the form dynamically exposes “When has this happened?”. Otherwise that question never appears.
- All 1 rule are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
About this template
A sleep study is scheduled around a single night, so the clinic benefits from knowing the pattern behind it before the patient arrives. This intake asks what the sleep concern actually is in the patient's own words, how long it has been happening, roughly how many hours they typically sleep, and whether they snore. The second page turns to what the day looks like afterward: whether daytime sleepiness is a problem, whether the patient has ever fallen asleep unintentionally during normal activities, which opens a short box only when it has happened, current medications, evening caffeine or alcohol use, and a typical bedtime and wake time. None of this replaces the study itself or scores the answers against a scale; it gives the clinic a written account of the pattern that brought the patient in, which is often more useful on the night than a form completed half-asleep at check-in.
What this form asks
Every question is editable — rename it, make it optional, or delete it entirely.
Page 1 — Sleep history
- Patient full namerequired
- Date of birthrequired
- Phone numberrequired
- Email addressrequired
- Describe your sleep concernrequired
- How long has this been happening?required
- How many hours do you typically sleep per night?required
- Do you snore?required
Page 2 — Daytime effects and history
- Do you feel excessively sleepy during the day?required
- Do you fall asleep unintentionally during the day?required
- When has this happened?
- Current medications
- Do you drink caffeine or alcohol in the evening?required
- Typical bedtime and wake timerequired
14 questions in total.
Example of a completed sleep study intake questionnaire
A sample intake showing how a patient describes their sleep pattern before a scheduled study.
- Patient full name
- Callum Reyes
- Describe your sleep concern
- Waking up tired most mornings despite going to bed early
- How long has this been happening?
- About six months
- How many hours do you typically sleep per night?
- 5 to 6
- Do you snore?
- Yes
- Do you feel excessively sleepy during the day?
- Yes
- Do you fall asleep unintentionally during the day?
- No
- Typical bedtime and wake time
- 10:30 PM to 5:30 AM
Sample data — no real people, addresses or records are shown.
How the form changes as it's filled in
This template ships with 1 conditional rule, grouped into 1 behaviour driven by 1 question. Everything below is already set up — edit or delete any rule once the template is in your workspace.
Driven by “Do you fall asleep unintentionally during the day?”
- Reveals questions
If “Do you fall asleep unintentionally during the day?” is Yes, the form reveals “When has this happened?”.
Set it up step by step
- 1
Send it well before the study night
Give the patient time to notice their own pattern over a few nights rather than filling it in from memory the same evening.
- 2
Read the daytime answers before the technician's briefing
Unintentional daytime sleep is the answer most worth flagging ahead of the study, not discovering during it.
- 3
Confirm evening habits close to the date
Caffeine and alcohol answers are only useful if the clinic also tells the patient what to avoid before the actual study night.
- 4
Keep it descriptive, not diagnostic
The form records what the patient reports; leave interpretation entirely to the clinician reviewing the study results.
Mistakes to avoid
- Asking the patient to self-rate severity on a scale instead of describing the pattern in their own words.
- Skipping the daytime section because the form focuses only on nighttime symptoms.
- Not confirming bedtime and wake time, which the technician needs to plan the study itself.
What it pairs with
Most teams don't run this form on its own. These are the forms and systems it sits next to.
- Comprehensive Patient History Form
- Patient Intake Questionnaire
- Nurse Triage Form
What to do with the responses
Review the intake ahead of the study, confirm any pre-study instructions with the patient, and pass flagged daytime answers to the reviewing clinician alongside the study results.
Works in both layouts
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Privacy & compliance
This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.
Frequently asked questions
Does this replace the check-in at the sleep lab?
No. It is background the technician reads beforehand; the lab will still have its own check-in and consent process on the night.
Should the patient bring a sleep diary as well?
If your clinic uses one, yes, and this form pairs well with it since the diary supplies the pattern over time and this captures the fuller picture.
What if the patient is unsure how many hours they sleep?
A rough estimate is fine; the study itself will measure the actual pattern far more precisely than a self-report can.
Is snoring alone a reason to worry?
The form does not answer that, and it should not try to; the reviewing clinician interprets the full set of answers alongside the study.
Is the Sleep Study Intake Questionnaire template free to use?
Yes. You can preview and test Sleep Study Intake Questionnaire on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Sleep Study Intake Questionnaire template ask for?
It asks 14 questions across 2 pages, 12 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Sleep Study Intake Questionnaire form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
1 conditional rule ships with the template: Features advanced show logic: if “Do you fall asleep unintentionally during the day?” is Yes, the form dynamically exposes “When has this happened?”. Otherwise that question never appears. All 1 rule are editable in the Logic tab, and the built-in checker warns about rules that contradict each other. All rules are editable in the Logic tab.
Where do responses to the Sleep Study Intake Questionnaire form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Sleep Study Intake Questionnaire form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
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