Please Complete This Short Application To Qualify For Your Sleep Breakthrough Session
(This will take less than 2 minutes to complete).
What's your name?
*
On average, how long does it take you to fall asleep?
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I'm out when my head hits the pillow
Up to 20 mins
20 mins - 1 hour
More than 1 hour
On average, how many hours of sleep do you get a night?
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7+ hours of sleep
6-7 hours
5-6 hours
4-5 hours
3-4 hours
Less than 3 hours
I get none without medication
What do you believe is affecting your sleep?
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What is your age range?
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14-24
25-34
35-44
45-54
55-64
65-75
75+
If you were confident that you could find effective help in achieving better sleep, would you be prepared to invest in your sleep health?
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Yes
No
Please only book a time you will be available. If you miss your appointment you will not be permitted to rebook. Are you committed to showing up to the session?
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Yes
No
Is there anything else you would like to add?
Finally, what is your best email? Once you click "Submit" you'll be redirected to book your free Sleep Breakthrough Session!
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