Vytality Health Early Access

Request edit access

Move up our waiting list by taking this survey. We want to hear what you have to say on caring for others and yourselves. Feel free to share this survey. Thank you! http://vytality.co

Email address *

More about you

Gender

Female

Male

Trans Female

Trans Male

Gender Variant/Non-Conforming

Not Listed

Prefer not to Answer

Other:

Age Group

18-24

25-34

35-44

45-54

55-64

65 and above

Marital status

Married

Never Married

Divorced/Seperated

Widow

What's your digital literacy?

I am tech savvy! I own a smartphone and use, understand, and analyze information from multiple apps

I know enough to get by. I only use my smartphone to call, text, and make appointments in my calendar

I only know how to gather information from the web (I only Google on my computer)

Other:

Would you describe yourself as a caregiver, care-receiver, or both?

Never submit passwords through Google Forms.

This form was created inside of Peakfoqus.

Forms