Order details for Kenneth Snell

Selected Prescriptions

Ambien (Zolpidem) Immediate-Release 10mg

1 Month Supply (30 Count)

Patient Profile

  • Gender: Male (62 Yrs)
  • DOB: Dec 11, 1963
  • Height: 5'9.00"
  • Weight: 230 lbs

Shipping To

Mr. Snell
1015 NW 9Th Pl Cape Coral
CAPE CORAL, Florida
33993

Contact Info

ken.6@alaska.net

(907) 398-3224

IP: 2600:387:f:5911::1 Order Date: Feb 16, 2026, 2:55 PM

SLEEP INTAKE RECORD:

Submitted: Feb 16, 2026

Patient Name

Mr. Kenneth Snell

DOB: 12/11/1963 (62 Yrs)

Contact Info

(907) 398-3224

ken.6@alaska.net

Physical Profile

Weight: 230 lbs Height: 5'9.00"

1. Experience with Sleep Difficulty Duration

✕ Less than 2 weeks
✕ 2-4 weeks
✕ 1-3 months
✓ More than 3 months

2. Main Sleep Issues

✓ Trouble falling
✕ Trouble staying
✕ Waking too early
✕ Unrefreshing

3. Time to Fall Asleep

✕ < 30m
✕ 30-60m
✓ > 60m
✕ None

4. Disrupted Nights Per Week

✕ 1-2 nights
✕ 3-4 nights
✓ 5-7 nights

5. Hours of Sleep Per Night

✓ < 4 hours
✕ 4-5 hours
✕ 6-7 hours
✕ > 7 hours

6. Daytime Impact

✓ Fatigue
✕ Poor focus
✕ Mood changes
✓ Performance
✕ None

7. Unintentional Daytime Sleep

✕ Yes
✓ No

8. Lifestyle Factors

✕ Caffeine > 2PM
✕ Alcohol for sleep
✕ Screens in bed
✕ Shift work
✓ None

9. Past Treatments/Supplements

✓ Melatonin/Mag
✕ Antihistamines
✕ Prescriptions
✕ CBT-I
✕ None

10. Treatment Effectiveness

✓ Not effective
✕ Somewhat
✕ Very

11. Medical History

✕ Sleep Apnea/Disorders
✕ Mental Health (Dep/PTSD)
✕ Sleepwalking/Behaviors
✕ Substance Misuse
✓ None

12. Current Medications/Substances

✕ Opioids
✕ Benzodiazepines
✕ Regular Alcohol
✕ Other Sedatives
✓ None

Patient Acknowledgment

Short-term use & No-alcohol policy

AGREED ✓