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Has a doctor ever told you that you have the following? restless leg syndrome (RLS)?

C. Restless legs 8. In the past year, while SITTING OR LYING DOWN, have you had any of the following symptoms? a. An urge to move your legs

C. Restless legs 8. In the past year, while SITTING OR LYING DOWN, have you had any of the following symptoms? b. Unpleasant or uncomfortable feelings in your legs

C. Restless legs [Questions #9-10 are about your MOST FREQUENT symptom you checked as yes in item #8.] 9. How often do you get this symptom? (check the one best answer)

C. Restless legs [Questions #9-10 are about your MOST FREQUENT symptom you checked as yes in item #8.] 10. How bothersome or troublesome is this symptom? (answer based on most frequent symptom) Does it bother you: (check one)

C. Restless legs [Questions #11-15 refer to all symptoms you checked as present in item #8.11.] These symptoms are most likely to occur when you are (check the one best answer):

C. Restless legs [Questions #11-15 refer to all symptoms you checked as present in item #8.11.] 12. Are they worse when you are sitting or lying down than when you are moving around or walking?

C. Restless legs [Questions #11-15 refer to all symptoms you checked as present in item #8.11.] 13. Do the symptoms improve if you get up and start walking?

C. Restless legs [Questions #11-15 refer to all symptoms you checked as present in item #8.11.] 14. What time of day do they occur? (check the one best answer):

a. If both day and night, do they get worse at night?

C. Restless legs [Questions #11-15 refer to all symptoms you checked as present in item #8.11.] 15. How old were you when you first noticed these symptoms? (write in "D" if Don't know) _____ _____ age in years (approximate OK)

Please indicate how often you experience each of the following. (check one box for each in items a through j) i. Leg jerks.

Please indicate how often you experience each of the following. (check one box for each in items a through j) j. Leg cramps.

Have you ever been told by a doctor that you have a sleep disorder (other than sleep apnea)? 18. What other sleep disorder? (check all that apply) b. Restless legs

In the past year, how often, on average, have you been awakened with leg cramps or leg jerks?