A sleep quality screening that scores three dimensions — duration, continuity and environment — on 1–5 self-ratings, then generates a personal AI PDF report with practical sleep-hygiene next steps and a QR into an AI sleep consultant chat.
Quick answer
A sleep quality screening asks about sleep duration, night-time waking and continuity, and the sleep environment on 1–5 agreement statements, scores the three dimensions and produces a personal AI PDF report with practical, non-clinical next steps.
Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified clinician before making care decisions.
Methodology: items are a structural adaptation of widely used clinical frameworks, not an official validated instrument; scores are indicative, not diagnostic.
“I sleep badly” hides three different problems — too little sleep, broken sleep, and a bedroom working against you. This screening separates them into three scored dimensions, so the report shows which lever to pull: schedule, night-waking patterns, or environment changes. It is self-reflection, not a diagnosis.
Sample form, AI PDF report and AI consultant — fill the form to unlock all three.
Everything you need to run this template.
From copy to deliverable in four steps.
Copy the form and its scoring, report and branding settings into your FormLM workspace — free.
Adjust fields, options and consent language to match your clinic workflow.
Send the link or QR; every response is captured automatically.
Open the personalized AI PDF report and share it with the patient or the chart.
Pick your role — see how it fits your clinic workflow.
Baseline sleep quality before coaching starts.
Clients arrive with a scored profile to discuss.
Find out whether the issue is time, waking or room.
What makes this template work as a professional clinical deliverable.
A preview of real statements respondents rate — the full version scores each answer 1–5 across three dimensions and generates a personalized, printable AI PDF report per respondent.
