Google ReCAPTCHA Test

This test by Terrill Thompson is designed to collect data regarding users' experiences with Google's ReCAPTCHA. My hope is to correlate their experiences with particular tools people are using to access the Web. See this blog post for background info. The form is divided into four parts:

Your contact info (in case I have a questions, but totally optional)
Some questions regarding the tools you're using
The CAPTCHA itself. Typically this is a required field but in my case it's not. You should be able to submit the form, even if you can't complete the CAPTCHA.
A comment field where you can share your experience with the CAPTCHA.

Part 1. Contact Info

Your name:

Your email:

Your Twitter username:

Part 2. Your Tools

What type of computer or device are you using?

Desktop computer
Laptop or notebook computer
Tablet
Phone
Other

What operating system are you using, including version?

What browser are you using, including version?

Have you used a mouse or other pointing device on this web page?

Yes
No

What assistive technologies are you using (if any), including versions?

Part 3. CAPTCHA

Part 4. Comments

Describe your CAPTCHA

A single checkbox
Checkbox plus additional Image/audio CAPTCHA
Other

Comments (describe your experience with the CAPTCHA)