Sleep Analysis Previous Next Our Ergocheck Testing and the information that you supply will take the guess work out of what mattress firmness is right for you on your side of the bed. Don't buy your next mattress without a proper Sleep Analysis conducted by a qualified Sleep Expert and a Medical Practitioner if you are under current care. A) Personal Information Your information remains confidential & will not be shared 1. First Name Last Name 2. E-mail Address (Required) 3. Age Select age: Under 18 years18 to 29 years30 to 39 years40 to 49 years50 to 59 years60 to 69 yearsOver 70 years 4. Gender Select gender: MaleFemale 5. Weight (Required) Select range: Under 139 lbs (63 kg)140 to 179 lbs (81 kg)180 to 219 lbs (100 kg)220 to 259 lbs (118 kg)260 to 299 lbs (136 kg )Over 300 lbs 6. Height Select height: Under 5' (<152cm)5' to 5' 5" (165cm)5' 6" to 5' 11" (180cm)6' to 6' 4" (193cm)Over 6' 5" (>195cm) 7. Is this mattress for you and a partner? Yes No If Yes, they should also submit their own Sleep Analysis. B) Mattress & Sleep Information 8. Preferred Sleep Position Back Side Stomach 9. Preferred Firmness Super Soft Soft Medium Soft Medium Medium Firm Firm Extra Firm Super Firm 10. Do you suffer from lower back pain? No Mild Moderate Severe 11. How long have you had your present mattress? < 3 years 3 to 5 years 6 to 10 years 11 to 15 years Over 15 years 12. What type of mattress do you presently sleep on? Innerspring Sofa bed Air bed Foam bed Water bed Futon 13. Do You want the bottom of you mattress to feel softer or firmer than the top? Softer 1 level Softer 2 levels Firmer 1 level Firmer 2 levels Same both sides 14. What are your 3 most important concerns about sleeping well? Select from the options below: My mattress is too hard My mattress is too soft My partner needs/prefers a different firmness I feel my partner's movements I have back pain I have bad neck pain I have pressure in my shoulders and hips I have acid-reflux My mattress has sagged prematurely I don't know what to buy Can I really afford it? C) Clinical Information (Optional) 15. Have you ever had back Surgery? Yes No 16. When was your last visit to a Chiropractor? Recently Over 6 months Last year Never 17. Are you presently under current care Yes No 18. Have you ever had an x-ray of your spine? Yes No 19. Additional Comments Submit Form "We are more than a mattress store, we are comfort and sleep experts."