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Sleep Quiz!
Please fill out this form to help us understand your sleep patterns and match you with the right therapist!
About You:
First name
*
Last name
*
Email
*
Age
*
Sleep struggles:
What best describes your sleep issues?
*
A
Can’t fall asleep
B
Wake up in the middle of night
C
Wake up to early
D
Restless or un-refreshing sleep
E
Anxiety around sleep
How often do you have trouble falling asleep?
*
A
Every night
B
Several times a week
C
Occasionally
D
Never
How many hours sleep do you usually get on week nights?
*
A
Less than 4 hours
B
4-5 hours
C
6-7 hours
D
8+ hours
Do you currently use any sleep medication?
*
A
Yes, regularly
B
Ocasionally
C
Never
How often to you experience anxiety or racing thought at bedtime?
*
A
Always
B
Sometimes
C
Rarely
D
Never
What's your typical bedtime?
*
A
Before 10pm
B
10pm - 12am
C
After midnight
Do you have a diagnosed sleep disorder?
*
A
Yes
B
No
C
Not sure
Submit
