Step 1 of 4
Which assessment would you like?
Select the area that matches your needs. Your choice will determine the questionnaire suited to your situation.
Sleep
Apnoea, insomnia, restless legs, CPAP device, daytime sleepiness…
Breathing
Asthma, COPD, breathing difficulty, chronic cough
Physical activity
Assessment of your physical activity level (IPAQ)
Nutrition
Adherence to the Mediterranean diet (PREDIMED)
CIRCASLEEP · Sleep
First consultation or follow-up?
Let us know whether this is a first sleep consultation or a follow-up appointment.
This is my first consultation
A few questions will help direct you to the right questionnaire and the right specialist.
I have already been seen — follow-up appointment
Book your appointment online directly with your specialist.
CIRCASLEEP · First consultation
What brings you here?
Select the situation that best matches your needs.
Insomnia, poor sleep
Difficulty falling asleep, night-time waking, unrefreshing sleep.
Snoring, apnoea, sleepiness
Screening for sleep apnoea (STOP-BANG) and daytime sleepiness (Epworth).
Restless legs
Unpleasant sensations and an urge to move the legs, especially in the evening.
CPAP device / mask / CPAP follow-up
Settings, mask and follow-up of your positive airway pressure (CPAP) treatment.
Another situation
Your situation does not match any of the previous options.
CIRCASLEEP · Insomnia
Which neuropsychologist?
Choose the therapist with whom you would like to book an appointment. Your answers will be shared with them to help prepare your consultation.
Emeline Houyoux
Book online; your answers are shared with them.
Maelik Poty
Book online; your answers are shared with them.
CIRCABREATH · Breathing
What is it about?
Select your breathing-related situation.
Asthma control
Wheezing, breathing difficulty, current treatment, clinical control (ACT).
COPD / emphysema
Chronic cough, breathlessness, phlegm, smoking history.
Another breathing problem
Book an appointment directly with the pulmonologist.
CIRCABREATH · COPD / emphysema
Screening or follow-up?
Let us know whether this is a first screening or follow-up of a previously diagnosed COPD.
COPD screening
A first screening based on your symptoms and risk factors.
COPD follow-up
COPD already diagnosed: CAT questionnaire followed by an appointment with the pulmonologist. A lung function test will be carried out during the consultation.
CIRCABREATH · COPD screening
Which screening option?
Choose the option that matches your needs.
I am only having a screening
The examination consists of a spirometry, without a consultation with the pulmonologist. Your results and recommendations are intended for your GP.
Screening and pulmonology consultation
Screening followed by a consultation with the pulmonologist (Dr Desplan).
Step 2 of 4
Personal details
This information will allow the CIRCAE team to identify your file and prepare your consultation.
Your answers constitute health data within the meaning of Article 9 of the General Data Protection Regulation (GDPR). They are collected for the sole purpose of preparing your medical consultation at the CIRCAE centre.
- Data controller: CIRCAE Centre, contact@circae.be
- Purpose: preparation of your personalised medical assessment
- Retention period: legal retention period for medical records (30 years)
- Rights: access, rectification, erasure — contact@circae.be
- This data is not shared with third parties
- Hosting: EU server (Belgium)
Step 3 of 4
Questionnaire
Please answer all the questions so your doctor can best prepare your consultation.
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Step 4 of 4
Review & submit
Check the information below before sending your questionnaire to the CIRCAE team.
Summary