* 1. Have you used a health journal before?

* 2. Why did you use a health journal?  Select all that apply

* 3. How well did the health journal help you track or improve your health?

* 4. What was your favorite feature(s) of the health journal you used?

* 5. What features were missing from the health journal you used?  Is there something you wished you could track or record that you couldn't?

* 6. Do you have a chronic illness?

* 7. How long did it take for you to get diagnosed?

* 8. How do you currently track your health information?

* 9. Will you be applying for Social Security Disability or for Long-Term Disability?

* 10. Would you like to receive an email when my new health journal is launched?

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