Please tell us a little bit about your Insomnia.
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Question 1 of 6
1. What are you struggling with? (You may choose multiple)
Anxiety about sleep
Staying Asleep through the night (Multiple Awakenings)
Waking up earlier than I want
Question 2 of 6
2. How long have you been struggling with insomnia?
Less than 3 months
Question 3 of 6
3. Are you having any challenges with the following? ( you may choose multiple)
Increased stress, anxiety, and or depression
Postponing or cancelling activities
Question 4 of 6
4. Do you currently do any of the following to fall asleep? (You may choose multiple)
Take prescription medication
Question 5 of 6
How did you hear about us?
Question 6 of 6
Additional Comments: Please share additional information.