Tell Us About Your Experience with Coronavirus

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1. How worried are you about coronavirus?

0 Virus Schmirus

Holding steady, for now

100 The friggin' sky is falling

Clear

i We adjusted the number you entered based on the slider’s scale.

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2. Have you been diagnosed with coronavirus?

Yes

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3. Have you been exposed to anyone with coronavirus?

Yes

Not that I know of.

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4. Has anyone you know been diagnosed with coronavirus?

Yes

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5. Do you have a compromised immune system?

Yes

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6. Does anyone close to you have a compromised immune system?

Yes

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7. What precautions are you taking to protect yourself and your loved ones? Check all that apply.

Wearing a mask in public

Avoiding large gatherings, including movie theaters and church services

Not eating out

Working from home

Not taking public transportation, including airplanes

Washing my hands religiously

Stocking up on hand sanitizer

Avoiding hand shakes and hugs

Other (please specify)

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8. Are you washing your hands and using hand sanitizer more often?

No, just about normal amount

Yes, slightly more often

Yes, much more often

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9. What about the current situation makes you most nervous? Check only one.

Getting sick and/or dying

Someone close to me getting sick and/or dying

An economic collapse

Impact on my job or personal financial situation

The loss of normalcy

The added stress as I go through the day

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10. If you work, has your employer asked you to work from home?

Yes

Not applicable

Other (please specify)

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11. If you have kids, have their schools been closed or moved to online classes?

Yes

Not applicable

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12. Have you canceled a business trip or vacation because of coronavirus?

Yes

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13. Have any events in your community or circle of friends been canceled?

Yes

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14. If so, which events have been canceled? Check all that apply

Church services

Local government meetings

Parties

Weddings

Civic meetings

Business conferences

Bridge clubs, book clubs or the like

Theater events

Art shows and openings

Music events

Fairs or festivals

Nothing cancelled

Other (please specify)

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15. How hard is it for you to not touch your face?

0 I'm a rock star at not touching my face

It's difficult but I'm doing OK not touching

100 Damn! I just touched it

Clear

i We adjusted the number you entered based on the slider’s scale.

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16. What questions do you have about cornonavirus? We will present them to experts and write an article in the future centered around answers to the most prevalent questions.

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17. What else do you want to tell us about your experience with or feelings about coronavirus?

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18. If you would be willing to be quoted in or interviewed for our story, please give us your name and email.

Name

Email Address

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* 1. How worried are you about coronavirus?

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* 2. Have you been diagnosed with coronavirus?

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* 3. Have you been exposed to anyone with coronavirus?

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* 4. Has anyone you know been diagnosed with coronavirus?

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* 5. Do you have a compromised immune system?

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* 6. Does anyone close to you have a compromised immune system?

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* 7. What precautions are you taking to protect yourself and your loved ones? Check all that apply.

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* 8. Are you washing your hands and using hand sanitizer more often?

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* 9. What about the current situation makes you most nervous? Check only one.

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* 10. If you work, has your employer asked you to work from home?

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* 11. If you have kids, have their schools been closed or moved to online classes?

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* 12. Have you canceled a business trip or vacation because of coronavirus?

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* 13. Have any events in your community or circle of friends been canceled?

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* 14. If so, which events have been canceled? Check all that apply

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* 15. How hard is it for you to not touch your face?

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* 16. What questions do you have about cornonavirus? We will present them to experts and write an article in the future centered around answers to the most prevalent questions.

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* 17. What else do you want to tell us about your experience with or feelings about coronavirus?

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* 18. If you would be willing to be quoted in or interviewed for our story, please give us your name and email.

1. How worried are you about coronavirus?

2. Have you been diagnosed with coronavirus?

3. Have you been exposed to anyone with coronavirus?

4. Has anyone you know been diagnosed with coronavirus?

5. Do you have a compromised immune system?

6. Does anyone close to you have a compromised immune system?

7. What precautions are you taking to protect yourself and your loved ones? Check all that apply.

8. Are you washing your hands and using hand sanitizer more often?

9. What about the current situation makes you most nervous? Check only one.

10. If you work, has your employer asked you to work from home?

11. If you have kids, have their schools been closed or moved to online classes?

12. Have you canceled a business trip or vacation because of coronavirus?

13. Have any events in your community or circle of friends been canceled?

14. If so, which events have been canceled? Check all that apply

15. How hard is it for you to not touch your face?

16. What questions do you have about cornonavirus? We will present them to experts and write an article in the future centered around answers to the most prevalent questions.

17. What else do you want to tell us about your experience with or feelings about coronavirus?

18. If you would be willing to be quoted in or interviewed for our story, please give us your name and email.