Sleep Risk Assessment

How are your sleeping habits impacting your health? 

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* 1. What time do you go to bed?

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* 2. Do you wake up with an alarm?

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* 3. What position do you sleep in?

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* 4. Do you wake up in the middle of the night?

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* 5. Do you wake up refreshed and energized?

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* 6. Rate your energy level.

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 7. How many cups of coffee do you have?

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* 8. Do you need to take medication or a supplement to sleep?

  always sometimes rarley never
Alcohol
THC/gummies
Melatonin
Sleeping Pills
Other Natural Supplements

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* 9. What time do you finish dinner?

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* 10. How long does it take you to fall asleep?

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* 11. How many hours do you sleep?

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* 12. Do you fall asleep with the tv on?

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* 13. Do you feel tired during the day and feel like you can fall asleep?

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* 14. Do you feel like you would like to hit snooze when you wake up?

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* 15. Rate your energy throughout the day.

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* 16. What best describes your current weight?

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* 17. What best describes your fitness level?

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* 18. How many glasses of alcohol do you consume per day on average?

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* 19. What best describes your THC/Marijuana intake?

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* 20. I remember my dreams?

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* 21. Do you tend to wake up in the middle of your dreams?

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* 22. If you got better sleep please select all that apply to you.

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* 23. Please rate your interest in the following.

  Very Interested Somewhat Interested A little Interested Not Interested
Working with a sleep coach to improve your sleep
Enrolling in an online sleep course and learn how to improve your sleep on your own
Join a monthly webinar lead by Dr. Sleep Right about sleep

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* 24. Address

T