Thank you for your interest in our lab! To participate in our studies, please fill in this sleep questionnaire to confirm your eligibility. We will contact you in due time to schedule you for our ongoing research.

Sleep Questionaire

Please fill in all fields unless stated otherwise.

Name
NRIC Number
Phone
E-mail
Age
Gender
Occupation
State current level of education if schooling
Are you right-handed from birth?



What is your preferred time for us to contact you? (check all that apply)










How did you hear about our sleep studies? (check all that apply)









If others, please specify



Would you like to be added to our mailing list for future sleep studies?



First Language?





If others, please specify



Do you have any metallic implants, parts, or fragments in your body (e.g., braces / dental retainers, replacement joints)?


If yes, please specify



Have you ever seen a doctor for a sleep-related, neurological, or psychiatric condition?


If yes, please specify



Do you have any chronic medical illnesses?


If yes, please specify



Please list any long term medications you are on





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