| 1) Do you feel you have a problem with sleep? |
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| 2) What is your age? |
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years
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| 3) What time do you fall asleep on a normal day? |
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| 4) What time do you wake up on a normal day? |
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| 5) What time do you wake up on a weekend or day off? |
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| 6) Do you consider yourself a morning person or an evening person? |
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