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As a BecomeHealthyNow.com visitor your opinions about health information and support are very important to us. By taking just one minute to let us know what you think, you will help ensure that we can provide you - and others who share your needs - with the information, help and support you are looking for. Your responses are completely confidential and will be used only by BecomeHealthyNow.com team to help improve our site.

1. Where do you live?

2. Age

3. Gender

4. Education

5. How did you find out about our site?
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Other:

6. How would you classify yourself?
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Seeking information on behalf of a friend/family member
Caregiver
Physician
Pharmacist
Nurse
Medical Student
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Other Health Care Worker
Media
Business

7. What medical condition are you most interested in?

8. What about our website did you like? Why?

9. What about our website did you dislike? Why?

10. Did our website influence you to buy our products or services? Positively None Negatively Why?
11. Do you find our website has adequate and well presented information? Like Ok Dislike Why?
12. Is the information within, easy to find and easy to read? Like Ok Dislike Why?
13. Is our website easy to navigate? Like Ok Dislike Why?
14. What would make you return to our website more often?
15. What do you think of the colors and the look? Like Ok Dislike Why?
16. What computer operating system do you use?	WinNT Win2000 Win98 Win95 Win 3.1 Mac Unix Other:
17. What size monitor and screen resolution do you use?	Monitor Size: Resolution Settings:
18. What web browser do you use?	Internet Explorer 5 Internet Explorer 4 Internet Explorer 3 Netscape 4 Netscape 3 AOL Other:
19. City/Town:
20. State/Province:
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22. Email Address: (Optional)
23. Any/ Other Questions, Comments, or Suggestions?
24. Would you like us to contact you? How?	Yes No How?


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