Intake Survey for Sleep Study
Thank you for completing this intake survey so we can obtain an accurate picture of how you feel before and after the study.
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Name *
Who invited you to this study? *
How severe is your sleeping problem during a normal week? *
Low
High
How many days per week do you experience sleeplessness? *
How long has this been a problem? *
What are you currently doing to relieve your symptoms of sleeplessness? How effective are those interventions? *
Do you experience side effects from using any of your current interventions? If so, please list.
If you could find a natural, more affordable, and effective way to alleviate your current symptoms, how ready are you to make a change? *
Have you ever used Zoom before for online meetups? *
Do you have the Intake and Exit Zooms on your calendar? If you need to know the dates and times, please reach out to the person who invited you. *
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