Are you satisfied with your sleep?

If your sleep needs improvement, what worries you? (check all that apply)?

How much does your quality of life suffer from sleep problems?

How much do these complaints interfere with your ability to function at home, at work, or with others?

How long have you had these sleep complaints?

What time do you usually go to bed?

Average time on weekdays (if variable: from - to):  o'clock
Average time on weekends (if variable: from - to):  o'clock

How much time thereafter do you turn off the light (close your eyes) to sleep?

After about: minutes

How long does it take you to fall asleep after lights off?

On average: minutes

How many times do you wake up per night?

About: time(s)

How long do you feel you are sleeping per night (minus any waking times)?

Approximately: hours

What time do you usually get out of bed to start your day?

On weekdays at about (if variable: from - to): o'clock
On weekends at about (if variable: from - to): o'clock

How important is it for you to have your sleep problems checked or treated?

Would you like to send your above answers to our Somnologie & Schlafcoaching practice for a short feedback?

How would you like us to contact you? (please provide an e-mail address or phone number):

Please let us know how to contact you.

The data collected will be forwarded to us by e-mail and never passed on to third parties. Refer to our privacy policy.


Inquiries and appointment

Consultations can take place in personal meeting on site or virtually via Zoom.

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Our current flyer (in German)

PDF, 1.6MB
We are happy to send printed copies for display in your practice, clinic or other institutional health service (counseling, physiotherapy, fitness, etc.).
Folded flyer, 10x21cm.

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Somnologie & Schlafcoaching GmbH
Trichtenhauserstrasse 2, CH-8125 Zollikerberg

Phone: 043 543 20 20