Teen Sleep Pattern Study Intake
Full Name
Age
School or Grade Level
Gender
Male
Female
Other
On average, what time do you usually go to sleep on weekdays?
On average, what time do you usually wake up on weekdays?
On average, what time do you usually go to sleep on weekends?
On average, what time do you usually wake up on weekends?
Do you use electronic devices before sleeping?
Never
Sometimes
Often
Always
Do you have trouble falling or staying asleep? Please describe.
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