Welcome to Your Sleep Health Screening!

On the next page you will be prompted to input your name and email address (optional), then the quiz will begin.

Disclaimer: The sleep health quiz you are about to take is intended for

informational purposes only and is not a diagnostic tool for any sleep issues. A comprehensive clinical interview and assessment are necessary for an accurate diagnosis. If you have concerns about your sleep health, please contact us for an evaluation.

Please fill out the brief form below with your full name and email address.

Full Name *

Last Name *

*By providing your email address, you consent to receive emails from Rhythm Wellness.

How hard is it to fall asleep most nights? *

Not at all

A little

Somewhat

Pretty hard

Very hard

(i.e. last 2 weeks)

How much trouble to have you have staying asleep in the middle of the night? *

Not at all

A little

Somewhat

A lot

It's really bad

(i.e. last 2 weeks)

Rate your difficulty with waking up too early and not being about to go back to sleep at all. *

None

Mild

Moderate

Severe

Very Severe

(i.e. last 2 weeks)

How SATISFIED/dissatisfied are you with your current sleep pattern? *

Very Satisfied

Satisfied

Neutral

Dissatisfied

Very Dissatisfied

How much do your sleep troubles get in the way of your ability to get through your daytime activities? *

Not at all

Barely

Somewhat

Much

Very much

(e.g. daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.)

How noticeable to others do you think your sleep problem is in terms of how much it impacts the quality of your life? *

Not at all noticeable

Barely

Somewhat

Noticeable

Very much noticeable

How WORRIED/distressed are you about your current sleep problem(s)? *

0 - Not At All

1 - A Little

2 - Somewhat

3 - Much

4 - Very Much

Do you snore loudly and/or do you feel excessively sleepy during the day? *

Yes

(Do you feel excessively sleepy even when you get a full night's sleep? Do you snore loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night?)