Silent Light

This short form helps us assess suitability for a professional snoring support program.

Your age (years)

Valid range: 34 to 65 years.

Q2 - Sex

Male Female Prefer not to say

Your height (cm)

Your weight (kg)

Used internally for BMI segmentation.

Q5 - Who is the primary snorer?

Me My partner Both of us

Q6 - How often does the snoring occur?

Occasionally (1-2 nights per week) Most nights Every night

Q7 - Has a medical professional mentioned sleep apnea?

No Suspected but not diagnosed Diagnosed mild Diagnosed moderate/severe

Silent Light is currently designed for habitual snoring and sleep disruption.

We recommend consulting your healthcare provider.

Q8 - What solutions have you tried before?

Mouth guards Nasal strips CPAP Nothing yet Other

Other (short text)

Q9 - How disruptive is the snoring?

1: Minor annoyance 10: Relationship emergency

Selected: 5/10

Q10 - Are you willing to participate fully?

Are you willing to:

Yes No

At this stage, full participation is required for this program.

You are welcome to return when you are ready.

I consent to GBLbiotech contacting me with additional questions if required.

Name

Email

Phone (optional)

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