Please answer the following questions:
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1. Please enter your first name.
2. Enter your e-mail address.
3. How did you hear about bmedSleep™?
--Please select--
Internet search
Television commercial
My doctor's office
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Web advertisement
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Other
4. What time do you usually go to bed?
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5. How long does it usually take you to fall asleep?
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6. How long are you awake during the middle of the night?
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7. What time do you wake up for the last time in the morning?
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8. What time do you get out of bed to start your day?
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9. How many nights per week do you have trouble sleeping?
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10. How long have you had trouble sleeping?
--Please select--
less than a week
1 to 4 weeks
1 to 3 months
4 to 11 months
1 to 3 years
4 to 10 years
more than 10 years
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