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Rainbow Home Units Fresh Air Survey
Free Fresh Air Machine
Survey open to your state's residence ONLY
OK
1.
Since living in the area, do you believe the air has gotten:
Much better
About the same
Much worse
2.
Does anyone in your family suffer from:
Asthma
Allergies
Breathing problems
3.
Do you have children or pets?
Children
Pets
Both
4.
Are you married or have a partner that resides with you?
Yes
No
5.
What do you do for work?
6.
What does your spouse/partner do for work?
7.
Age group?
18-25
26-30
31-40
41-55
56-65
66-70
70+
8.
Do you own or rent?
Own
Rent
9.
Contact information: (we will contact you by phone)
Name
Address
City/Town
State/Province
ZIP/Postal Code
Phone Number
10.
Who sent you? (first and last name)
Current Progress,
0 of 10 answered