2.1) |
Entering bed on date (day/ month/ year): |
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2.2) |
Leaving bed on date (day/ month/ year): |
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Leave blank for indefinate occupation |
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2.3) |
Reason for occupying bed: [Tick all that apply] |
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2.4) |
Size of bed: |
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2.5) |
Preferred style of bed:
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2.6) |
Total time to spent in bed (in seconds): |