Thank you for joining me today and taking the time to learn a little more about your sleep.

Before you go, take 2 minutes to reflect on your sleep patterns and what your body may be communicating.

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1. What’s your full name? (Required.)

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2. What’s the best email to reach you at? (Required.)

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3. How long does it usually take you to fall asleep after you intend to go to sleep? (Required.)

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4. On how many nights did you wake during the night and have difficulty returning to sleep? (Required.)

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5. Overall, how would you rate the quality of your sleep? (Required.)

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6. How often did you wake feeling refreshed or restored? (Required.)

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7. How much did poor sleep affect your daytime functioning - such as energy, concentration, mood, motivation, or ability to carry out your usual activities? (Required.)

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