Request edit access
Wireless Mobile Devices (WMD) Behavior Assessment Scale (15 quick questions!)

Dear J.T. Moore Community Member,

We are looking forward to meeting you soon! 

Ahead of our visit/webinar, could we ask for a huge favor please? Would you please take this 15-question survey called the WMD-Balance Scale? 

What is WMD, you may ask? Wireless Mobile Devices include smartphones, smartwatches, tablets, ipads, virtual reality eyewear, laptops, and all other screens including television, and video games.

Purpose of this scale: Behavior assessment and learning scale for an undistracted, enjoyable life 

We have designed this scale to help our audience gain a better insight into their relationship with their devices. If the students, teachers and parents could take this survey by Wednesday, March 20, we can present impactful anonymous data during our time with your community.

It is a fun questionnaire that often gets people thinking and smiling! 

* Your answers will be kept confidential.

Do you need to speak with me ahead of our visit to the campus? Please email me at 

See you soon!

Nidhi Gupta, MD

CEO and Founder

Phreedom Foundation

KAP Pediatric Endocrinology

Sign in to Google to save your progress. Learn more
Email *
Name (First and Last) *
I am a: *
(For students only)
I am in Grade:

1. Do you find yourself mindlessly checking your WMD many times a day, even when you know there is likely nothing new or important to see?


2. Do you seem to lose track of time when on your WMD?

3. Do you regularly procrastinate important activities (work, assignments, exercise, sleep) due to your WMD use? *
4. Have your parents, partner or friends complained about your WMD overuse (e.g., spending too much time in the toilet, on streaming channels, video gaming or online shopping, etc.)? *
5. When your WMD ring, beep, or glow, do you feel an intense urge to check for texts, posts, emails, updates, etc.? *
6. Do you wish you could be a little less involved with your WMD? *
7. Do you text, email, browse or post while driving, working, or doing other similar activities that require your focused attention and concentration? *
8. Do you have your WMD in your mind even when you are not using them? *
9. Do you sleep with your WMD near you, under the bed, near the bed, under your pillow, bedside table) regularly? *
10. Do you spend time on your WMD right before you fall asleep? *
11. Do you feel reluctant to be without your WMD, even for a short time? *
12. Do you feel bored when doing other stuff without your WMD? *
13. Does your WMD or social media use make you feel lonely? *
14. How often do you message/email people via your WMD when the people you are messaging/emailing are in the same room? *
15. Do you feel the world would be a better place if people used their WMD more judiciously? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Phreedom. Report Abuse