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.
Please fill in all fields unless stated otherwise.
| Name | | |
| Phone | | |
| E-mail | | |
| Age | | |
| Gender |
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| Occupation |
State current level of education if schooling | |
| Are you right-handed from birth? |
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| What is your preferred time for us to contact you? (check all that apply) |
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| How did you hear about our sleep studies? (check all that apply) |
If others, please specify
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| Would you like to be added to our mailing list for future sleep studies? |
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| First Language? |
If others, please specify
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| Do you have any metallic implants, parts, or fragments in your body (e.g., braces / dental retainers, replacement joints)? |
If yes, please specify
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| Have you ever seen a doctor for a sleep-related, neurological, or psychiatric condition? |
If yes, please specify
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| Do you have any chronic medical illnesses? |
If yes, please specify
Please list any long term medications you are on
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