Sleep Care - Starwood Wealth Management Group

Sleep Care MD

Help us out by filling up this short but important Sleep Wellness Survey !

Your Company Code Number (Number can be found in the email, from HR Department regarding the Sleep wellness survey)*

What is your Age ?*

What Is your Gender ?

On average during a Weekday, How many Hours of sleep do you get per night?*

On a Average Weekday Do you feel rested when you wake up in the morning?*

Do you Use a CPAP to Sleep ?

Do you know or have been told that you Snore ?*

Are you often tired, fatigued or sleepy during the day?*

Do you know if you stop breathing or has anyone witnessed you stop breathing while you are asleep? *

Do you have high blood pressure or take medication to control high blood pressure?*

What is your Height ?*

What is your Weight ?*

How Likely are you to Doze off or Fall Asleep in the following situations, in contrast to just feeling tiered ?

Sitting & Reading *

Watching TV *

Sitting inactive in a public place (e.g a theater or a meeting) *

As a passenger in a car for an hour without a break *

Lying down to rest in the afternoon when circumstances permit*

Sitting & talking to someone *

Sitting quietly after a lunch without alcohol *

In a Car, while stopped for a few minutes in traffic *