Request to use sleep measure/instruments

Prefix PrefixDr.Mr.Ms.Prof.

First Name

Last Name

Email Address

Sleep measure/instrument requested (please select one) Sleep measure/instrument requested (please select one)Pittsburgh Sleep Quality Index (PSQI)Brief Behavioral Treatment for Insomnia (BBTI)

Organization

Country

Source of Funding Source of FundingNot FundedNIH FundedFederally Funded (non NIH)Industry SponsoredOther

Brief Description of Project

Modification Requested (if required)

If other, funding source

How did you hear about this instrument?

Additional Comments