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ModPodPillows Prototype Questionnaire I

ModPodPillows – Prototype Application

This short questionnaire helps us understand your sleep and whether the ModPodPillow prototype may be suitable for you.

This is not a medical assessment.

Section & - About You

Age Range

Age Range
A
B
C
D

Height (approx.)

Height (approx.)
A
B
C
D
E
F

Weight Range (optional)

Do you sleep alone?

Do you sleep alone?
A
B
C

Every Day Pain and Other Symptoms

Do you suffer from any of the following during the day? (tick as many as apply to you)

Do you suffer from any of the following during the day? (tick as many as apply to you)

Do you suffer from any of the following after or during sleep? (tick as many as apply to you)

Do you suffer from any of the following after or during sleep? (tick as many as apply to you)

Are your pain symptoms affected by sleep?

Are your pain symptoms affected by sleep?

Has anyone commented on your sleep (snoring, restlessness)?

Has anyone commented on your sleep (snoring, restlessness)?
A
B
C

Section 2: Your Current Sleep

Overall sleep quality

Overall sleep quality
A
B
C
D
E

Average sleep per night

Average sleep per night
A
B
C
D
E

How often do you wake uo in the night?

How often do you wake uo in the night?
A
B
C
D

Do you feel rested on waking?

Do you feel rested on waking?
A
B
C
D

Section 3: Sleeping Position & Movement

Usual sleeping position when falling asleep

Usual sleeping position when falling asleep
A
B
C
D
E
F

Position you usually wake up in

Position you usually wake up in
A
B
C

Movement during the night

Movement during the night
A
B
C

Do you use more than one pillow?

Do you use more than one pillow?
A
B
C

If yes why? (tick as many as apply)

If yes why? (tick as many as apply)

Snoring & Breathing

Have you been told that you snore?

Have you been told that you snore?
A
B
C

If yes, how would you describe it?

If yes, how would you describe it?
A
B
C

Have you ever been diagnosed with sleep apnoea?

Have you ever been diagnosed with sleep apnoea?
A
B
C

Are you currently using any sleep-related treatment?

Are you currently using any sleep-related treatment?

Pillows and Past Experience

Pillows tried in the last 2 years

Pillows tried in the last 2 years
A
B
C
D

Typical spend on pillows

Typical spend on pillows
A
B
C
D

What leads you to change your pillow?

What leads you to change your pillow?

What level of support does your current pillow offer?

What level of support does your current pillow offer?
A
B
C
D

What level of support does your current mattress offer you?

What level of support does your current mattress offer you?
A
B
C
D

Motivation & Suitability

Why are you interested in this prototype?

Why are you interested in this prototype?

What would success look like to you?

What would success look like to you?

Feedback & Participation

Are you happy to test an early-stage prototype and provide honest feedback?

Are you happy to test an early-stage prototype and provide honest feedback?
A
Untitled multiple choice field
A
B

Would you be willing to:

Would you be willing to:

May we use your anonymised feedback in product development and marketing?

May we use your anonymised feedback in product development and marketing?
A
B

Any additional comments? (you can also tell us why you particularly would like to be accepted for this trial)

First and Last Name:

Phone Number:

Email:

Final Confirmation

I understand this is a prototype product and not a finished retail item, and that my feedback helps shape future versions.

I understand this is a prototype product and not a finished retail item, and that my feedback helps shape future versions.
A