Smart Meter Health Effects Question Title * 1. Do you know if you currently have a "smart" meter or radio frequency emitting device on your home/apartment? Yes No Question Title * 2. If you do have one, do you know when it was installed? Yes No Question Title * 3. Did you have a negative health response immediately when the RF emitting "smart" meter was installed? Yes No Don't know Question Title * 4. Have you tried to get the power company or anyone to remove it? Yes No Question Title * 5. Were you successful in removing it? Yes No Question Title * 6. Are you currently having health problems? Yes No Question Title * 7. Would you associate any of your health problems with the presence of the RF emitting "smart" meter(s)? Yes No Question Title * 8. Describe the symptoms or health problems you have experienced since the installation of the RF "smart" meter. Headaches Sleeping problems Difficulty concentrating Memory loss Depression Fatigue Excitability/Anger outbursts Rapid mood swings Blood sugar problems Tingling in extremities (toes, feet, fingers, etc.) Thyroid problems Allergies Liver disfunction Hormonal disturbances Heart problems Eye/vision problems Other (please specify) Question Title * 9. Did you know that "smart" meters are surveillance devices for collecting your personal usage and behavioral data to be sold for profit by your electric company to corporations (and made permanently available to police, state and federal agencies) wanting your personal inside-home information? Yes No Question Title * 10. Will you financially support or participate in a movement to have local legislation passed in NC (as other states have successfully done) to ensure an opt-out to RF meters? (see http://raleighes.info/Support/Funds.html) Yes No Done