A Better You Wellness (FKA A Better Snooze)

Client Sleep Intake Questionnaire

Please correct the errors described below.

Client Demographics

If currently using a sleep tracker, enter 5 latest sleep score(s), separated by comma.

Sleep History & Current Sleep Patterns

Behavioral Health & Physiology

Nutrition and Lifestyle

Sleep Environment

Previous Attempts to Improve Quantity or Quality of Sleep

By submitting this form, I acknowledge that I am seeking support with some type of sleep-related challenge. If I opt for a video call, I will be fully clothed on camera at all times. I do not have permission to record the session and I will NOT misuse the video conferencing software for any inappropriate purpose. If I engage in any misconduct, I understand that I jeopardize access to services, immediately and in the future.

Your information will be encrypted.

Loading...