Sleep Assessment
Take our Sleep Assessment to receive your sleep analysis report. You'll receive your analysis report in your email within 24-48 hours after completion.
Full Name
*
First Name
Last Name
Phone Number
Please provide a mobile number in case we need to reach out to you for clarification about your assessment.
E-mail
*
example@example.com
Gender
*
Male
Female
Other
Age group
*
20-29
30-39
40-49
50-59
60-69
70+
Which is the bigger challenge for you?
*
Falling asleep
Staying asleep
How long have you struggled with your sleep?
*
Less than 1 month
1-3 months
3-6 months
1-5 years
5-10 years
10+ years
How many times during the night do you wake up AND have a hard time falling back to sleep??
*
0
1
2
3
4+
On average, how long does it take you to fall asleep?
*
Less than 15 mins
15-30 mins
1-2 hours
2-3 hours
4+ hours
Do you have trouble getting up in the morning or feel groggy upon waking?
*
Most of the time
Sometimes
Never
Are you more sad or emotional from not sleeping?
*
Yes
No
Do you have a hard time focusing or concentrating?
*
Yes
No
Are you more irritable with people?
*
Yes
No
Do you have sleep anxiety, "bed dread” or feel stressed about sleep in the evening?
*
Yes
No
Do you have a hard time remembering things or experience brain fog?
*
Yes
No
Are you currently taking sleeping aids or medication?
*
Yes
No
How confident are you in your current plan to figure out your sleep issue?
*
Very confident I don’t really need help. I’m just curious
Somewhat I need help figuring it out
Not at all… I REALLY need help
After we send you your personal sleep analysis report, would you like to our help implementing it to accelerate your journey to consistent natural sleep?
*
Yes, absolutely
No thanks not at this time
How much would you be willing to invest in a sleep solution that works for you? Please be as accurate as possible here. Your response doesn't change our program pricing... but it helps us understand your budget, coaching support options within your budget, and importance.
*
I don’t have finances now, and I’m unable to find them
$200-1K as much as a T.V, furniture or appliance
$1k-$3K as much as a nice vacation or a new computer
$3-5K as much as a bathroom or kitchen update
I’ll invest what I need to as long as it works for me
Are you friendly and coachable
*
Yes, absolutely
No
How are your sleep issues impacting your life and your health (please be specific)?
tag
Submit
Should be Empty: