---
title: Restless Legs Syndrome Screening Questionnaire Template | Paperform
description: Professional RLS screening form for healthcare providers to assess symptom severity, sleep impact, and determine treatment options. Includes validated criteria and iron studies evaluation.
url: "https://paperform.co/templates/restless-legs-syndrome-screening-questionnaire"
type: static
generatedAt: "2026-03-28T00:45:04.018Z"
---

[← Back to free form templates](/templates/)    ![Restless Legs Syndrome Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/restless-legs-syndrome-screening-questionnaire.png)
    [Preview](https://_preview.paperform.co/ai-template/restless-legs-syndrome-screening-questionnaire) [Use this template for free](/create?ai-template=restless-legs-syndrome-screening-questionnaire)    [Intake Forms](/templates/category/intake-forms/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Streamline Your Restless Legs Syndrome Assessment with Paperform

Restless legs syndrome (RLS) affects millions of people worldwide, causing uncomfortable sensations and an irresistible urge to move the legs. For healthcare providers, accurate screening and assessment are essential to provide timely, effective care.

This **Restless Legs Syndrome Screening Questionnaire** template helps medical practices, sleep clinics, and neurology offices efficiently gather comprehensive patient information. The form walks patients through validated symptom criteria, sleep quality assessment, and medical history—all before their appointment.

#### Why This Template Works for Healthcare Providers

Rather than relying on paper forms or fragmented intake processes, this template creates a streamlined digital experience. Patients can complete the questionnaire from home, providing detailed information about symptom severity, frequency, and impact on daily life. The form uses conditional logic to adapt questions based on responses, ensuring you gather relevant clinical information without overwhelming patients.

Healthcare administrators and medical assistants can use this form to pre-screen patients, flag those who may need iron studies or specialist referral, and prepare providers with comprehensive data before consultations. The structured format makes it easy to identify patterns and track symptom progression over time.

#### Automate Your Clinical Workflows with Stepper

Once a patient submits their RLS screening, you can use [Stepper](https://stepper.io) to automate your clinical workflow. Route high-severity cases directly to your scheduling system for priority appointments, trigger lab orders for iron studies when indicated, send personalized follow-up emails with educational resources, or update your EHR with structured data—all without manual data entry.

This template is ideal for neurologists, sleep medicine specialists, primary care physicians, nurse practitioners, and medical practices focused on improving patient outcomes while reducing administrative burden. With Paperform's healthcare-grade security (SOC 2 Type II compliant) and flexible integrations, you can confidently digitize your RLS assessment process and focus on what matters most: providing excellent patient care.
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