Autism FreeZone Member Survey
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1. Default Section
1
. Are you directly impacted by Autism?
Are you directly impacted by Autism?
Yes
No
2
. Check the product catagories you currently purchase.
Check the product catagories you currently purchase.
Gluten-free casein-free products
Other special dietary products
Vitamins and Supplements
Sensory integration (Gross/Fine/Oral Motor)
Lab tests
Prescription Medications (Not covered by insurance)
3
. Please add additional categories of things you buy here.
Please add additional categories of things you buy here.
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4
. What specialty companies do you buy from most often?
What specialty companies do you buy from most often?
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5
. What grocery store do you buy from most often?
What grocery store do you buy from most often?
6
. Do you have items that you want to post to the Autism FreeZone marketplace right now?
Do you have items that you want to post to the Autism FreeZone marketplace right now?
Yes
No
7
. Our site allows you to list what you are looking for.
What items will be on the top of your Wish-List?
Our site allows you to list what you are looking for. What items will be on the top of your Wish-List?
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8
. Do you attend any Autism related conferences?
Do you attend any Autism related conferences?
Yes
No
9
. Which conferences have you attended?
Which conferences have you attended?
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10
. How did you find out about Autism FreeZone?
How did you find out about Autism FreeZone?
11
. The following is optional.
The following is optional.
Name:
Email Address:
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