*1.Contact Info(Required.)

Name

Phone

E-Mail

City, State

Gender

Age

*2.Before proceeding, to assist in determining eligibility, please confirm the following statements are true:

● I have not been diagnosed with vertigo and do not experience regular dizziness or imbalance
● I do not experience regular migraine headaches I do not experience claustrophobia
● I have not been diagnosed with epilepsy and do not experience seizures
● I have not been diagnosed with a neurological disorder
● I am not pregnant and do not plan to imminently become pregnant
● I am willing to spend time in a virtual reality environment including aural, visual, and/or haptic stimulus
● There are no other reasons why I do not wish to participate [or believe that doing so could make me uncomfortable](Required.)

Yes, the above statements are true

No, one or more of the above statements is not true

*3.Which of the following devices do you own and use?(Required.)

Laptop/Computer

Gaming Console

VR Headset

Tablet

Mobile Phone

Portable 5G Hotspot

None of these