2. Real Name:

3. How did you first locate SelfhelpMagazine's web site?

I found it using a search engine.
(Please specify: ) Yahoo Alta Vista WebCrawler Lycos Excite Other (please specify)
Specify other search-engine.

I "hyperlinked" or was transferred to SelfhelpMagazine from another internet site.
I "hyperlinked" or was transferred to SelfhelpMagazine from an email post.
I "hyperlinked" or was transferred to SelfhelpMagazine from a newsgroup post.
I directly accessed SelfhelpMagazine.

3a. If you directly accessed SelfhelpMagazine, from which of the following sources did you obtain the home page address? (Mark all that apply.)

My psychotherapist My physician Friend, coworker, or relative told me about it Saw it in a mental health trade publication Saw it in a newspaper or another magazine Heard about it at a convention Other (Please specify: ) If other, where?

4. In total, how much time have you spent at SelfhelpMagazine?
Less than 10 minutes 10-30 minutes 31-60 minutes Over one hour

5. How many times have you visited SelfhelpMagazine?
This is the first time 2-3 times 4-9 times 10 or more times

6. In the left-hand column, tell us why you first visited SelfhelpMagazine. If you have visited us more than once, indicate why you returned in the right-hand column. (Your answers will help us. Please mark all that apply.)

7. Which of the following phrases would you use to describe SelfhelpMagazine? (Mark all that apply.)

8. How likely are you to visit the SelfhelpMagazine again?

9. Which areas of SelfhelpMagazine are most useful? (Mark all that apply.)

10. Which areas of the SelfhelpMagazine web site are disappointing? (Mark all that apply.)

11. If we offered brief, online courses for your self-help or psychological needs, would you be interested in taking them from the comfort of your home?

Yes
No
Unsure

11a. If yes, what topics would you like to have covered in such a course?

11b. If yes, how much would you think would be fair for us to charge you if offered by a professional, and if they offered weekly web-based chat sessions when you could discuss topics, plus readings for 8-12 weeks?
$19.95
$29.95
$39.95
$49.95
$59.95

12. Are you, or is anyone in your household, a mental health practitioner?
Yes
No

13. How old are you?
Less than 20 20-29 30-39 40-49 50-59 60-69 70+

14. Are you ... ? Female Male

By choosing to send a message to SelfhelpMagazine, you acknowledge that all information contained in your message, including questions, comments, suggestions, etc., shall not be deemed confidential, and SelfhelpMagazine shall be free to use, reproduce, disclose, and distribute the information to others within SelfhelpMagazine without limitation.