CORE & PURE

Email *

Name *

Mobile Number *

Age *

Sex *

Profession *

Organization/Institution Name *

City *

State *

1. In the last month, how frequently have you felt tensed or anxious without a clear reason to the point where it interferes with your ability to perform daily tasks? *

Almost Daily

A few times in a month

Several times in a month

Hardly ever

Please select an option.

2. How often you feel issues like lack of concentration, mood swings, reduced productivity or remembering things that you normally wouldn’t have trouble with? *

Almost Daily

Several times in a month

Occasionally

Rarely

Please select an option.

3. Do you find yourself less interested in social activities, hobbies or isolating from friends and family which you used to like earlier? *

Yes

No

Not sure

Please select an option.

4. Do you experience physical symptoms such as headache, dizziness, muscle tension, back pain, fatigue, gastrointestinal issues, etc? *

Yes, regularly

Yes, occasionaly

No

I have not noticed

Please select an option.

5. Do you find it difficult to fall asleep at night, or you wake up during the night and have trouble going back to sleep, at least two times a week? *

Yes

No

Maybe

Please select an option.

6. How often do you wake up feeling tired or exhausted despite a full night’s sleep? *

Almost daily

Several days in a week

Occasionally

Rarely

Please select an option.

7. Do you find that you need to rely on caffeine, tea or other stimulants to stay awake or alert during the day? *

Every Day

Most Days

Occasionally

Rarely

Please select an option.

8. On average, how many hours you sleep each night? *

Less than 6 hours

6-7 hours

7-8 hours

More than 8 hours

Please select an option.

9. How many days in a month, you normally take off due to stress or sleep issues? *

10. Have your stress levels or sleep difficulties impacted your irritation, frustration, work or personal relationships? *

Yes, significantly

Yes, somewhat

Occasionally

Not at all

Please select an option.

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Stress and Sleep Study

We are conducting study on Stress & Sleep
to design and create support systems for
happy and healthy minds.

Offers

Stress and Sleep Study

We are conducting study on Stress & Sleep to design and create support systems for happy and healthy minds.

Express Checkout

Offers

Order Summary

We are conducting study on Stress & Sleep
to design and create support systems for
happy and healthy minds.