Survey Homes A few simple questions can guide you to better sleep
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Sleep intake form

What age range are you in?

This helps tailor the sleep assessment to your general stage of life.

Sleep intake form

What best describes your main sleep concern?

Choose the issue that feels most important right now.

Sleep pattern

How often do you struggle with sleep?

Think about the last few weeks, not just one unusually bad night.

Falling asleep

How long does it usually take you to fall asleep?

Estimate the average time from lying down to actually falling asleep.

Night waking

How often do you wake up during the night?

Choose the option that feels closest to a typical night.

Morning recovery

How do you usually feel when you wake up?

Your morning energy can reveal a lot about sleep quality.

Daytime symptoms

How sleepy do you feel during the day?

Include afternoon dips, difficulty focusing, or fighting to stay alert.

Breathing check

Have you noticed any of these during sleep?

Select any that apply. This helps flag symptoms that may need extra attention.

Stress and routine

How much do stress or racing thoughts affect your sleep?

This includes overthinking, anxiety, or feeling mentally “switched on” at bedtime.

Sleep habits

Which bedtime habits may be affecting your sleep?

Pick all that apply. These factors commonly make it harder to wind down.

Sleep support history

What have you tried before for sleep support?

Choose the option that feels most accurate for you.

Preference

What type of support fits you best?

Your preference helps shape the final recommendation style.

Safety screen

Are any of these relevant to you?

Select any that apply so the survey can keep the guidance appropriate and cautious.

This survey is for general sleep wellness guidance only and is not a diagnosis or medical advice.
Final details

Tell us a little about your current sleep pattern.

These final details help make your summary feel more personal and complete.

Reviewing your responses

Preparing your sleep summary...

We’re checking your sleep pattern, habits, stress level, and symptom flags to build a more relevant result.

Reviewing your nighttime routine
Checking falling-asleep and wake-up patterns
Flagging any symptoms that may need extra attention
Matching your preferred support style
Your sleep summary

Your sleep profile is ready.

Here is a short, personalized summary based on the answers you gave during the intake.

Personalized result
See Sleep Support Option
If you have severe daytime sleepiness, breathing pauses, gasping during sleep, or persistent sleep problems, it may be worth speaking with a qualified healthcare professional.