INSTRUCTIONS: This health questionnaire has 10 questions. You will be invited to complete this questionnaire three times: once now and again within the next couple of weeks as smart meters are being put in Sedona starting April, 2014, and then within the next few months after smart meters installations are complete. The purpose of the questionnaire is to determine any changes in your health status during this period. While the results will be published your identity will remain confidential. We ask you to identify yourself (with initials) and your Zip Code only so we can compare your first, second and third questionnaire responses. If you are a business location, please feel free to send questionnaires for all employees willing to participate.
Providing your contact information will enable us to anonymously plot your location on a Sedona map to see if there are clusters around cell phone antennas and towers, high intensity electromagnetic antennas, or to identify other areas of concern including clusters of electromagnetic problems.