| Name: | |
| Email Address: | |
| Phone: | |
| How many texts do you send a day ? | 1-5
5-10
10-15
More than 15
More than 25
None |
| Sex | Male
Female |
| Age | |
| Why do you text? | |
| Have you ever texted while driving? | Yes
No |
| Have you been in car accident because of texting? | Yes
No |
| Have you ever texted while riding a bike? | Yes
No |
| Have you ever texted while walking? | Yes
No |
| What's the wildest thing you've done while texting? | |
| Have you ever injured yourself while texting? | Yes
No |
| If you have injured yourself while texting explain how. | |
|
