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English

Welcome to Elva Health!

Українська English

We are happy to accompany you on your journey to better sleep. Sleep is not just rest, but the foundation of your energy, mood and health. This questionnaire will help us understand you better and create a personalized sleep recovery plan. All your data is confidential. You are in safe hands

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1. Full Name

3. Date of birth

2. Your contact phone number

4. Contact e-mail

Access to the patient's personal account will be sent to the email address you provide

5.

 Which communication channel is most convenient for you?

TELL US ABOUT YOUR BODY

6. Gender:

7. What is your weight?

30 kg

8. Your height

9. Your age

10.

 How would you describe your sleep right now?

11.

 How long have your sleep problems lasted?

12.

 Do you use anything to improve your sleep?

13.

 Do you feel exhausted during the day?

14.

 Do you work nights or shifts?

15.

 Do you have children under 5 years old?

16.

 Do you have any sleep-related diagnoses?

17.

 Are you actively involved in sports?

18.

 Are you experiencing age- or hormone-related sleep changes?

This will help us focus on the main thing

19.

 What are your treatment goals?

Thank you for your time!

Your answers will be taken into account by the doctor during the appointment

An email with a password has been sent to your email.

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