Do you experience daytime fatigue?
Frequently Occasionally Rarely Never Not sure
How many hours of sleep do you typically get per night?
Less than 5 hours 5-6 hours 6-7 hours 7-8 hours More than 8 hours
Do you consume caffeinated beverages during the day?
Yes, frequently Yes, occasionally No, rarely No, never Not sure
How often do you engage in physical activity?
Daily Several times per week Once a week Rarely Never
Do you take naps during the day?
Frequently Occasionally Rarely Never Not sure
Have you consulted a healthcare professional about your fatigue?
Yes No Planning to
All set, how can we reach you?
Name
Email
Phone
(Details here)
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    Say Goodbye to Daytime Fatigue

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