Does My Sleep Routine Need Help? from Sana Psychological.

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Do you wake up not feeling as rested as you would like or feel that you should?* This field is required.

YESNO

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Do you find yourself going to bed more nights than not after midnight?* This field is required.

YESNO

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Do you get 7 hours of sleep (or less) on most nights?* This field is required.

YESNO

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Do you find yourself procrastinating or delaying going to bed, even though you're tired?* This field is required.

YESNO

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Would you like to be more physically active during the day?* This field is required.

YESNO

6

Do you often eat food after 8pm?* This field is required.

YESNO

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Do you often consume stimulating, engaging, and/or upsetting content (books, media, news, etc.) shortly before bed?* This field is required.

YESNO

8

Do you put yourself to sleep using TV?* This field is required.

YESNO

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Do you find yourself uncomfortable in your bed?* This field is required.

YESNO

10

Is your room too noisy, hot, and/or bright at night?* This field is required.

YESNO

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Have you needed to use sleep aides (prescription or over-the-counter medication) more often than not to help you sleep?* This field is required.

YESNO

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Has it been suggested to you to explore sleep conditions and/or sleep hygiene?* This field is required.

YESNO

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Would you like to improve your quality of sleep?* This field is required.

YESNO

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What is your email? We'll send you more info.* This field is required.You may receive recommendations & free resources from Sana Psyc; you are free to unsubscribe at any time.

example@example.com

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Calculation

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Sorry :( This form is only availble in Canada

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