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1. Do you have, or have you sometimes experienced, recurrent, uncomfortable feelings or sensations in your legs while sitting or lying down?

2. Do you have, or have you sometimes experienced, a recurrent need or urge to move your legs while sitting or lying down?

3. When present, do these feelings or movements improve or go away when you get up and walk around, for as long as you are walking?

4. Are these uncomfortable feelings, or this urge to move, worse in the evening or at night, compared with the morning?

5. During the last 12 months, have these uncomfortable feelings or sensations in your legs, or the need to move your legs while sitting or lying down, happened to you on average for one or more nights/days per week?

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© SWA 2017 for Littlewick Medical Centre. Originally coded by Patrick Halls.