Sleep Support Session — Intake Form

Welcome

Thank you for beginning your Sleep Support session.

There is nothing you need to explain perfectly.

Simply share whatever feels most relevant right now, in your own words and at your own pace.

Your responses will help guide the support created for you.

Company

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Name(Required)

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Email(Required)

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Phone

Location / Timezone

What feels most present for you at the moment?

What would you most like support around right now?(Required)

You do not need to explain everything. Simply share what feels most important or emotionally present.

How has your sleep been affected lately?

difficulty falling asleep

waking during the night

shallow or restless sleep

waking too early

vivid dreaming

waking emotionally overwhelmed

tension before sleep

difficulty switching off mentally

stress-related sleep disruption

feeling tired but unable to rest deeply

inconsistent sleep patterns

other

How emotionally or physically exhausted do you currently feel?

1 = manageable 10 = deeply overwhelmed or exhausted

Are there particular times when things feel more difficult?

evenings

late at night

after work

after social interaction

after difficult conversations

during emotional stress

when alone

no particular pattern

other

What would feeling more rested or supported look like for you right now?

Is there anything else you would like me to know?

I understand that Sleep Support is a complementary wellness support offering and is not intended to diagnose, treat, cure, or replace medical, psychological, or emergency care.

yes

no

I understand that experiences vary from person to person and that this work is approached gently and without guaranteed outcomes.

yes

no