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Name
*
First
Last
Email
*
1. What is your age range?
*
Under 18
18-24
25-34
35-44
45-54
55-64
65 or Older
2. What is your gender?
*
Male
Female
Non-binary
Prefer not to say
3. What is your current living situation?
*
Living alone
Living with family
Living with roomate(s)
Living with partner
Other
Please specify
4. What is your main objective for seeking a companion?
*
5. How often would you like to interact with your companion?
*
Daily
A few times a week
Once a week
A few times a month
Once a month
As needed
6. What type of communication do you prefer?
*
Text Messaging
Audio Calls
Video Calls
A combination
Please specify
7. What are your interests and hobbies?
8. Which of the following topics are you comfortable discussing with your companion? (Select all that apply)
*
Personal life and relationships
Work and career
Mental health
Physical health
Hobbies and interests
Spirituality and religion
Politics
Others
Please specify
9. Do you have any preferences regarding the background of your companion? (Select all that apply)
*
Gender
Age range
Professional background
Cultural background
Language(s) spoken
No preference
10. Are you interested in a licensed professional, non-licensed professional, or are you open to either option?
*
Licensed professional
Non-licensed professional
Open to either option
11. Are there any specific challenges or goals you would like to address with your companion?
*
12. What are your expectations for your companion in terms of support and motivation?
*
13. How important is it for your companion to share similar interests and hobbies with you?
*
Very important
Somewhat important
Neutral
Not very important
Not Important at all
14. In the future, would you be open to interacting with a digital companion avatar?
Yes
No
Unsure
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