ICER Sleep Diary
Sleep is the most enigmatic part of our life. We spend almost one third of our life sleeping and yet not aware about the importance of good night's sleep which is vital for our survival.

Our technology driven life style does not allow us to get quality sleep and hence many types of sleep disorders are on rise in recent years.

Maintenance of sleep diary is a prerequisite for sleep quality assessment. Following questionnaire will allow you to fill the data twice a day - after waking up in the morning and before going to bed. It is recommended to submit data of at least seven consecutive days for assessment.

This diary is developed by Institute of Chronobiology Education & Research (ICER, Pune). You are requested to fill the section 1 only once. In the subsequent data entry, only mandatory field of mail id may be provided.


CONSENT

I, the undersigned, voluntarily agree to take part in the study.

I have been given a full explanation by the scientific investigators of the nature and purpose of the study.

I have been given the opportunity to question the investigators on all aspects of the study, and have understood the advice and information given as a result.

All documentation held on a volunteer is in the strictest confidence and complies with the Data Protection Act (2013). I agree that I will not seek to restrict the use to which the result of the study may be put.

I confirm that I have read and understood the above and freely consent to participating in this study. I have been given adequate time to consider my participation and agree to comply with the instructions and restrictions of the study.
Email address *
Name
Time of Birth
Gender
Age (yrs)
Height (cm)
Weight (kg)
Blood group
Postal address (city, country, pin code)
Current occupation
Clear selection
Shift work (other than 8 am - 5 pm job) in last three months
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