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Sleep Programme Application form

What is your first name

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What is your email address

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Confirm your email address

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Do any of the following apply to you?

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Bipolar disorder, psychosis, schizophrenia, or other psychotic disorders

Current severe depression or mental health crisis

Active suicidal ideation or self-harm risk

Dissociative disorders (e.g. DID) or significant history of dissociation

PTSD or complex trauma currently in active flare-up

Currently under psychiatric care with an unstable or recently changed diagnosis, or recent psychiatric hospitalisation

Epilepsy or other seizure disorders

Recent significant head injury or concussion

Diagnosed sleep apnoea, narcolepsy, or other sleep disorder

Parasomnias (sleepwalking, night terrors)

Pregnancy

Currently under the influence of alcohol or recreational drugs

Severe cardiovascular conditions

Under 18 years old

None of the above

Are you aware of any medical, psychological or other reason why taking part in this sleep programme may not be suitable for you?

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A

Yes

B

No

Terms & Conditions

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Click here to read the Terms & Conditions

I have read and agree to the Terms & Conditions

Right to cancel

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I want the ClearPath Audio programme to begin immediately and understand that, once digital content has been supplied, I may lose my 14-day right to cancel that digital content.

Privacy Notice

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Click here to read the Privacy Notice

I explicitly consent to ClearPath Audio using the health information I provide solely to assess whether I am eligible for this programme, and I have read the Privacy Notice