SLEEP DISORDERED BREATHING QUESTIONNAIRE FOR CHILDREN

The initial fields should be filled out at first appointment, and the follow up fields should be completed after 3 months of treatment. Please identify the following symptoms your child exhibits with the scale indicating the severity of the symptoms..

  • 0 = Not Present
  • 1-2 = Mild
  • 3 = Moderate
  • 4-5 = Pronounced

  • Does your child:

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  • SPEECH QUESTIONNAIRE

    To be filled out only if #27 was indicated.


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