RedMed Pilot Survey - Neurovalens

Unique Patient ID
Week Number:*
These questions are based on the Insomnia Severity Index that attempts to define the severity of both the nighttime and daytime impacts of insomnia over the past month.
Difficulty falling asleep*

1

2

3

4

5

1 is Not Difficult, 5 is Very Difficult
Difficulty staying asleep*

1

2

3

4

5

1 is Not Difficult, 5 is Very Difficult
Do you have problems waking up too early?*

1

2

3

4

5

1 is Never, 5 is Always
How satisfied are you with your current sleep pattern?*

1

2

3

4

5

1 is Very Satisfied, 5 is Very Unsatisfied
How noticeable to others do you think your sleep problem is in terms of impairing the quality of your life*

1

2

3

4

5

1 is Not noticeable, 5 is Very noticeable
How worried are you about your current sleep problem?*

1

2

3

4

5

1 is Not worried, 5 is Very worried
How disruptive to your daily life do you think your sleep problem is?*

1

2

3

4

5

1 is Not disruptive, 5 is Very disruptive
ISI SCORE
On average, how many days per week did you use the Modius Sleep device?*
If you missed using the device on some days, what was the main reason? (Select all that apply)

Forgot to use itToo busy / no timeDidn't feel effectiveExperienced discomfortOther
Please rate your agreement with the following statements:
The Modius Sleep device was easy to use*

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
The Modius Sleep device was comfortable to wear*

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
It was easy to integrate the Modius Sleep device into my daily routine*

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
Any other comments relating to ease of use, comfort or integrating Modius Sleep into your daily routine?
Treatment Preference & Importance of Drug-Free Solutions
How likely are you to prefer Modius Sleep over medication for sleep treatment?*

Very LikelyLikelyUnlikelyVery Unlikely
How important is it for you to have a drug-free treatment option for insomnia?*

Very LikelyLikelyUnlikelyVery Unlikely
Any other comments relating to Modius Sleep as a drug-free solution?
Overall Satisfaction & Additional Feedback
On a scale of 0 to 10, how likely are you to recommend Modius Sleep to a family member or friend suffering from insomnia or trouble sleeping*

0

1

2

3

4

5

6

7

8

9

10

0 is Not at all likely, 10 is Extremely likely
How satisfied are you overall with your experience using Modius Sleep?*

Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied
If you could change anything about the device or your experience, what would it be? *
Would you be willing to share a quote about your experience?
Should be Empty: