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Want to know more about Ambien?

Submit your experience with Ambien or Ambien CR to this study. Participants may opt to receive a copy of the study results.

Submit your experience

Use this form to submit your experience to the Ambien Experience study. Clicking the Submit button indicates that you have read and agreed to the Research Consent Agreement.

Do you want to receive the study results by email?:

If "Yes," please type your email address:

Geographic area (state or country):

Age:

Gender:

Marital status:

Condition for which Ambien was prescribed:

Prescribing physician:

If "Other," please type the physician's specialty:

Ambien dosage:

Dates Ambien was taken:

How did Ambien affect your sleep?:

Describe any side effects:

Comments: