*1.Contact Info(Required.)

Name

Phone

E-Mail

Gender

Age

City

State

*2.Do you consent to take part in this survey to help us improve Products?(Required.)

Yes

No

*3.Before proceeding, to assist in determining eligibility, please confirm the
following statements are true:(Required.)

True

False

I have not been diagnosed with vertigo and do not experience regular dizziness or imbalance

True

False

● I do not experience regular migraine headaches I do not experience claustrophobia

True

False

● I have not been diagnosed with epilepsy and do not experience seizures

True

False

● I have not been diagnosed with a neurological disorder

True

False

● I am not pregnant and do not plan to imminently become pregnant

True

False

● I am willing to spend time in a virtual reality environment including aural, visual, and/or haptic stimulus

True

False

● There are no other reasons why I do not wish to participate [or believe that doing so could make me uncomfortable]

True

False

*4.Do you currently own & use a Virtual Reality headset?

Not Required(Required.)

Yes

No, but i intend to buy one in the next 6 months

No, but i intend to buy one longer than 6 months from now

No and have no intention to buy one