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Free Sleep Score Questionnaire
Your results will be emailed to you upon completion.
What is your name
*
What is your email address?
*
How many hours do you sleep on average per night?
*
How many hours do you sleep on average per night?
A
Less than 6 hours
B
6-7 hours
C
7-8 hours
D
More than 8 hours
How often do you wake up feeling refreshed?
*
How often do you wake up feeling refreshed?
A
Never
B
Rarely
C
Sometimes
D
Often
E
Always
Do you struggle with focus at work due to poor sleep?
*
Do you struggle with focus at work due to poor sleep?
A
Yes
B
No
How often do you use caffeine to stay alert?
*
How often do you use caffeine to stay alert?
A
Never
B
Rarely
C
Sometimes
D
Often
E
Daily
Do you experience stress or anxiety that affects your sleep?
*
Do you experience stress or anxiety that affects your sleep?
A
Yes
B
No
How often do you use screens (phone, laptop, TV) in the hour before bed?
*
How often do you use screens (phone, laptop, TV) in the hour before bed?
A
Never
B
Rarely
C
Sometimes
D
Often
E
Always
Do you wake up frequently during the night? (eg due to noise, discomfort, or needing the bathroom)
*
Do you wake up frequently during the night? (eg due to noise, discomfort, or needing the bathroom)
A
Yes
B
No
How would you describe your sleep environment?
*
How would you describe your sleep environment?
A
Very poor
B
Poor
C
Average
D
Good
E
Excellent
What's your biggest sleep challenge?
*
What's your primary goal for improving your sleep?
*
Submit
