Molly Survey
Exit this survey

1. Molly Survey

1. Your location (City, State, ZIP code) AND your age

Your location (City, State, ZIP code) AND your age

2. Before seeing this survey, had you ever heard of the Molly Drug?

Before seeing this survey, had you ever heard of the Molly Drug? Yes

No (If you answered NO, please skip to #10)

3. How long have you been aware of Molly?

How long have you been aware of Molly? Less than 3 months

Between 3 months and 1 year

More than 1 year

4. How do you know about Molly? (Check as many that apply.)

How do you know about Molly? (Check as many that apply.) Friend

Family member

Media (Web, newspaper, magazine, TV)

Other

5. Do you know what Molly is made of?

Do you know what Molly is made of? Yes

If you answered YES, please list the ingredients here:

6. Check which of the following statements you believe to be true:

Check which of the following statements you believe to be true: Molly is legal

Molly is illegal

7. Check which of the following statements you believe to be true:

Check which of the following statements you believe to be true: Molly is a dangerous drug

Molly is a relatively harmless drug

Regardless of which answer you checked, please explain briefly:

8. Do you know how Molly affects a person -- physically and/or psychologically?

Do you know how Molly affects a person -- physically and/or psychologically? Yes

If you answered YES, please list all of the effects you are aware of:

9. Have you or people you know ever tried Molly or a drug you or the others were told was Molly?

	Yes	No
Myself	*Have you or people you know ever tried Molly or a drug you or the others were told was Molly? Myself Yes	Myself No
People I know	People I know Yes	People I know No

If you answered YES to either choice, would you be willing to speak with us further? If so, please provide your email address or phone number.

10. If you answered Questions #3 through #9, do NOT answer question #10.
Have you or your friends ever used drugs recreationally?

	Yes	No
Myself	*If you answered Questions #3 through #9, do NOT answer question #10. Have you or your friends ever used drugs recreationally? Myself Yes	Myself No
Friends	Friends Yes	Friends No

Check out our sample surveys and create your own now!

form {display:none;} #jserror {text-align:center;margin-top:50px;}Javascript is required for this site to function, please enable.