Digital Behavior Tracker Form
Share your digital habits, screen time, app usage, and online routines to help track and set digital wellness goals.
Full Name
*
First Name
Last Name
Age Group
*
Please Select
Under 18
18-24
25-34
35-44
45-54
55+
On average, how many hours per day do you spend on screens (phone, computer, tablet, TV)?
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Which devices do you use most frequently?
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Smartphone
Laptop/Desktop
Tablet
Smart TV
Wearable (e.g., smartwatch)
Other
Which apps or platforms do you use most often?
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Instagram
Facebook
TikTok
YouTube
Snapchat
WhatsApp
Email
Other
What time of day do you spend the most time online?
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Early morning (6am-9am)
Daytime (9am-5pm)
Evening (5pm-9pm)
Late night (9pm-2am)
How often do you intentionally take breaks from screens?
*
Multiple times daily
Once daily
A few times a week
Rarely/Never
How would you describe your current digital habits?
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Very balanced
Somewhat balanced
Needs improvement
Unbalanced
What is your main goal for improving your digital habits?
*
Please Select
Reduce overall screen time
Limit social media use
Increase productivity
Improve sleep quality
Other
Anything else you’d like to share about your digital behavior or goals?
Submit
Should be Empty: