How Bad is Your Sleep?

How Bad is Your Sleep?

This brief questionnaire is designed to assess the severity of your insomnia.


Remember, the more honest you are in responding the more accurate the results.


Based on those results Live Simply Well will coordinate with you to design your personalized Sleep Refresh plan to help your establish, and maintain the restorative (restful) sleep you desire, and deserve.

Please include area code, or Country number (if appropriate)

If referred by a physician please provide name and contact information. This information will be used to coordinate with your physician as needed.

None Mild Moderate Severe Very Severe
Difficulty falling asleep
Difficulty staying asleep
Problems waking up too early