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* 1. Have you recently stopped using marijuana after a period of regular use?

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* 2. What is your primary problem with sleep?

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* 3. How long have you had the sleep problem?

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* 4. Have you experienced any of the following?

  Yes No
Touble getting to sleep at night
Long periods when you wake up and are not able to return to sleep
Wake up often during the night
Wake up too early and can't fall back asleep
Fatigue or excessive daytime tiredness
Vivid or disturbing dreams
Nighttime sweating

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* 5. Do you feel dependent on marijuana for a good night's sleep?

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* 6. What is your gender?

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* 7. What is your age?

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* 8. How long have you been using marijuana? (Please select the closest estimate.)

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* 9. In the past year, how frequently have you used marijuana on average?

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* 10. In the past 60 days, how frequently have you used marijuana?

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* 11. Have you used marijuana to improve sleep?

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* 12. For what purpose do you use marijuana?

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* 13. How available is marijuana to you if you want to get it?

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* 15. Can we share your responses with our community (anonymously)?

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