The Deep Sleep Solution
Program Application
PleaseĀ fill out this application for the program. We want to make sure we can help you and it's a right fit.
Ā
Is this your first time applying for our help?
This is My First Time Applying
I've Applied Before
Have you been diagnosed with an anxiety or mood disorder? If so, are you under the care of a healthcare provider for this?
Yes
No
Prefer to not answer
Are you currently taking any prescription sleep medications?
Yes
No
Are you currently on Hormone Replacement Therapy?
Yes
No
Have you been diagnosed with Sleep Apnea?
Yes
No
How much would you be willing to invest in a solution that works for you? Please be as accurate as possible.
Don't have the finances now, but maybe in the future.
$200 to $1k - As much as a nice TV or furniture.
$1k to $3k - As much as a nice vacation.
$3k to $5k - As much as a bathroom upgrade.
I'll invest what I need to as long as it works for me.
Submit Application
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