SCREENING FORM

Completion of the Screening Form does not obligate you in any way to participate

in a research study.

 

Please note that you may end this session at any time. However, your answers

will be transmitted only after you click "Submit Form" in the final section.

 

If your computer has problems displaying our Screening Form, or if you are uncomfortable filling out the form online, we can interview you by phone.

University of Pennsylvania 

Behavioral Sleep Medicine Program

215-7-INSOMN

insomnia@upenn.edu

https://www.med.upenn.edu/bsm/