Sleep Profile Step 1 of 12 8% Let's Get Started!Name First Last Do you see a Chiropractor? Yes No I have before, but I do not currently Did a Chiropractor or Doctor refer you? Yes No Name of Your Chiropractor or Doctor (Please include City and State) Tell Us About YourselfAge Height Weight GenderThis question helps us configure firmness and comfort levels for your mattress. Male Female Prefer not to say Standing at the foot of the bed, what side do you sleep on? Left Side Right Side In the Middle How long have you owned your current bed? Less than 1 year Less than 5 years More than 5 years What type of bed do you currently own? Spring Memory Foam Memory Foam/Spring Hybrid Latex Air Water Let's talk about your current sleep experience.Do you sleep with a partner?If so we'll ask about your partner later to help you both get your best sleep. Yes No What is your preferred sleep position? (check any that apply) On my side On my back On my stomach I toss and turn all night How would you rate your sleep?1 = I can't sleep without sleep aids. 10 = I sleep great. No issues. 1 2 3 4 5 6 7 8 9 10 How many hours of sleep do you get a night (on average)? 4 5 6 7 8 9 10 Do you have a history of chronic pain (6 months or more)? Yes No Occasionally Where is the location of this pain? How intense would you rate your pain?1 = No pain. 10 = Worst possible pain. 1 2 3 4 5 6 7 8 9 10 Are there other issues that affect your sleep? We're almost done asking about you.Do any of these apply to you? Limited mobility Temperature sensitivity loss (Diabetic) I require a specific bed height Do you suffer from Acid Reflux symptoms (sometimes referred to as G.E.R.D)? Yes No If you or your partner are having issues with Acid Reflux (or GERD), an adjustable foundation can help. For $400 off any adjustable base, use the code: ACID400How active are you?1 = Not active. 10 = Very active. 1 2 3 4 5 6 7 8 9 10 Do you wake up at night? If so, what are the reasons (check all that apply) Joint or muscle pain. Trips to the bathroom. My partner snores. My bed's just not comfortable. Other reasons If you or your partner are having issues with snoring, an adjustable foundation can help. For $400 off any adjustable base, use the code: SNORE400Do you have a temperature sensitivity when sleeping? I sleep hot I sleep cold I don't have a temperature sensitivity If you or your partner is normally a cold sleeper, we recommend our patented Comfort Sense heating system. Tell us about your PartnerIf you sleep with a partner, we strongly encourage you to fill out this section together.Your Partner's Name Age Height Weight GenderThis question helps us configure firmness and comfort levels for your partner. Male Female Prefer not to say Can you tell us a little about your partner's sleep experience?What is your partner's normal sleep position (check any that apply) On their side On their back On their stomach They toss and turn all night How would your partner rate their sleep?1 = I can't sleep without sleep aids. 10 = I sleep great. No issues. 1 2 3 4 5 6 7 8 9 10 How many hours of sleep does your partner get a night (on average)? 4 5 6 7 8 9 10 Does your partner have a history of chronic pain (6 months or more)? Yes No Occasionally Where is the location of this pain? How intense would your partner rate this pain?1 = No pain. 10 = Worst possible pain. 0 1 2 3 4 5 6 7 8 9 10 Are there other issues that affect your partner's sleep? We're almost finished!Does your partner suffer from Acid Reflux symptoms (sometimes referred to as G.E.R.D)? Yes No If you or your partner are having issues with Acid Reflux (or GERD), an adjustable foundation can help. For $400 off any adjustable base, use the code: ACID400How active is your partner?1 = Not active. 10 = Very active. 1 2 3 4 5 6 7 8 9 10 Does your partner wake up at night? If so, what are the reasons (check all that apply). Bathroom Partner snoring Pain General discomfort Other reasons If you or your partner are having issues with snoring, an adjustable foundation can help. For $400 off any adjustable base, use the code: SNORE400Does your partner have a temperature sensitivity? They sleep hot They sleep cold They don't have a temperature sensitivity What will you most look forward to when you get your iSleep bed? A full night of sleep. More energy during the day. No more waking up stiff and sore. All of it, I'm ready for all of it! We appreciate you taking the time to fill out your Sleep Profile. Your information will help us build your ideal iSleep mattress.Email PhoneCAPTCHA
