# Intention form for contracting licenses by health professionals

SleepUp is a global startup of personalized and clinically validated Digital Therapy for the treatment, prevention of insomnia, and sleep monitoring, being the first in Brazil to have the approval of ANVISA.

Platforms includes therapeutic modules, relaxation and meditation resources, reports, sleep diary, clinical trials, anamnesis and telemedicine. The monitoring feature by wearables (wearable technologies) is under development and will be released soon.

SleepUp's purpose is to provide a non-pharmacological, affordable and effective solution for insomnia and subjective sleep complaints. We are based on the integral and personalized health of the patient. In this way, the health professional can use SleepUp in combination with pharmacological treatment to obtain a better clinical outcome, greater efficacy, engagement and adherence to medical management.

Therefore, professionals such as doctors, psychologists, physiotherapists, dentists, among others, will be able to acquire licenses and prescribe for their patients. We also offer a medical portal for patient management, with access to tests and anamnesis performed, as well as a sleep diary and all the data that the patient includes for the therapeutic process.

The purpose of this form is to understand your demand so that we can serve you in the best possible way.

We kindly ask you to fill in the form with the information below, to speed up and optimize our accreditation process. If you have any questions, contact Thabita at 11-97081626. Thanks!

## Email

## How did you hear about SleepUp* Required
- Social networks
- Participation in events
- app store
- internet search
- Others

## Full name

## What is your CRM, CRP or other class entity record?

## Solicitação das licenças seria para uso de clínica (mais de um profissional) ou para consultório particular?*
- Clínica
- Consultório

## Quantos pacientes com queixas de sono você ou sua clínica atendem por mês? (média)*
- Até 10 pacientes
- De 11 a 20 pacientes
- De 21 a 50 pacientes
- De 51 até 100 pacientes
- Mais de 101 pacientes

## What is your specialty or the specialty served by the clinic? (you can tick more than 1 option)* Required
- Cardiologist
- general practitioner
- Endocrinologist
- Physiotherapist
- Gynecologist
- Geriatrics
- Family doctor
- sleep doctor
- Occupational Physician
- Neurologist
- Oncologist
- Psychologist
- Psychiatrist
- Other

## Você já faz uso de algum recurso tecnológico para ajudar no tratamento de distúrbios do sono dos seus pacientes?*
- Sim
- Não

If you answered yes to the previous question, please explain what the feature is.

## Submit

Thank you for your message, we will contact you shortly.