Atomic Shrink, Incorporated

​818-481-6581

Insomnia Severity Index | Dr. Patricia Masuda-Story
Confidential patient questionnaire

Insomnia Severity Index

Current, i.e. Last 2 Weeks

The Insomnia Severity Index has seven questions. The seven answers are added up to get a total score. When you have your total score, look at the 'Guidelines for Scoring/Interpretation' below to see where your sleep difficulty fits.

Patricia Masuda-Story, Psy.D., QME drstory@atomicshrink.com
Questionnaire progress0 of 7 answered

Patient Information

Enter the patient information before completing the scale.

Instructions

For each question, please CIRCLE the number that best describes your answer.
Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).
Total Score 0 / 28
After selecting “SEND COMPLETED FORM,” the device’s email application will open with the score and responses addressed to Dr. Story. Select Send in the email application to complete delivery.