SLEEP COACHING QUESTIONNAIREPlease complete the following questions Name * First Name Last Name Email * Questionnaire - Please answer as accurately as possible. Do you suffer from any of the follow? Please check all that apply Trouble falling asleep at night Trouble staying asleep Waking up too early and not being able to fall back asleep Frequently waking up during the night Excessive daytime drowsiness/fatigue Nightmares that impact your ability to get a good night of sleep Excessive grumpiness and drowsiness upon waking up in the morning None of the above Sleep habits * I have a consistent bedtime and wake-up time (including on weekends) Strongly Disagree Disagree Neutral Agree Strongly Agree I like to watch TV or use my computer in bed Strongly Disagree Disagree Neutral Agree Strongly Agree I like to use my phone in bed Strongly Disagree Disagree Neutral Agree Strongly Agree I find my bedroom to be a relaxing and peaceful environment Strongly Disagree Disagree Neutral Agree Strongly Agree I like to go to bed with a glass of water Strongly Disagree Disagree Neutral Agree Strongly Agree I routinely exercise within a couple hours before bedtime Strongly Disagree Disagree Neutral Agree Strongly Agree I wake up feeling refreshed and ready for the day Strongly Disagree Disagree Neutral Agree Strongly Agree I like to hit snooze on my alarm before getting out of bed Strongly Disagree Disagree Neutral Agree Strongly Agree I sleep more on weekends than weekdays Strongly Disagree Disagree Neutral Agree Strongly Agree I like to eat a meal close to bedtime Strongly Disagree Disagree Neutral Agree Strongly Agree My bedroom has to be pitch black for me to fall asleep Strongly Disagree Disagree Neutral Agree Strongly Agree My bedroom has to be completely silent for me to fall asleep Strongly Disagree Disagree Neutral Agree Strongly Agree Do you sleep in the same bed with someone else? * Yes No Prefer not to say What does the perfect night of sleep look like to you? How many hours of sleep do you get on average a night? * Be honest! Please select an answer 1 2 3 4 5 6 7 8 9 10 11 12 I don't know How many hours of sleep would you like to get a night? * Please select an answer I don't know how much I need! 1 2 3 4 5 6 7 8 9 10 11 12 Thank you! I will get back to you shortly with your plan. Please give me 2-3 business days to get everything together.
