Name *

First Name

Last Name

Do you sleep 7 or more hours each night? *

Yes

No

Is your sleep disrupted throughout the night (waking up for more than 10 minutes at a time)? *

Yes

No

Do you need to consume caffeine throughout the day in order to stay awake and perform at your best? *

Yes

No

Do you accumulate 10 minutes or more of psychological relaxation per day? *

(e.g., reading, meditation, breathing exercises, mindfulness, etc.)

Yes

No