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PERSONAL PROFILE QUESTIONNAIRE
Prepared for Mind Alive Inc. by Brain Gym PR March, 2012
I. REST
1) Approximately, how many hours do you sleep at night?
less than 3 hours
4-6 hours
7-9 hours
2) Do you sleep all night long without interruptions or
sleeplessness?
Yes
No
3) When you lay down to sleep, do you fall asleep within the first
half hour?
Yes
No
4) Do you take any medication for sleep?
Yes Which one? __________ Since when? _____________
No
5) Do you find yourself dwelling on a particular concern or worry
that interferes with your sleep?
Yes. Specify: ____________________________
No
6) When you wake up, do you feel tired?
Always
Often
Sometimes
Rarely
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