Logit is a simple extension for Google Chrome that enables you to keep custom daily notes, without sharing any data anywhere. It works by automatically opening the app whenever you open a new tab, once a day at your own convenient time. This means that you can fill up the form and it will remind you to fill it up the next time you open a new tab, so you're good to go.

It will also send an e-mail with a link to the form, so you don't need to worry about sending anything.

This is a Chrome extension, which means that it requires Chrome to be installed.