Survey

1. Health Conditions

*
1. Name

Name First Name
Last Name

*
2. Gender

Gender Male

Female

3. Work Phone Number

Work Phone Number

4. Cell Phone Number

Cell Phone Number

*
5. Best contact number between the hours of 9am-7pm

Best contact number between the hours of 9am-7pm

*
6. Age

Age

7. Have you heard that Schlesinger Associates is re-branding our database? InspiredOpinions has officially been launched to the Schlesinger Associates community! The new site combines all of Schlesinger's research efforts in one place so that you have an even greater chance to earn and learn - all while having a say.

Chances are you have received an invitation to join so check your inbox for an email from Schlesinger Associates regarding InspiredOpinions. Be sure to activate your profile on the new site or if you prefer, please provide your email and we’ll send an invitation out to you. (The email will be from heatherc@inspiredopinions.com)

Have you heard that Schlesinger Associates is re-branding our database? InspiredOpinions has officially been launched to the Schlesinger Associates community! The new site combines all of Schlesinger's research efforts in one place so that you have an even greater chance to earn and learn - all while having a say. Chances are you have received an invitation to join so check your inbox for an email from Schlesinger Associates regarding InspiredOpinions. Be sure to activate your profile on the new site or if you prefer, please provide your email and we’ll send an invitation out to you. (The email will be from heatherc@inspiredopinions.com) Email Address

8. Race

Race White or Caucasian

Hispanic or Latino

Black or African-American

Asian-American or Pacific Islander

Native American or American Indian

Other (please specify)

9. Do you or anyone in your household work in any of the following fields?

	Yes	No
Marketing or market research	*Do you or anyone in your household work in any of the following fields? Marketing or market research Yes	Marketing or market research No
Advertising or public relations	Advertising or public relations Yes	Advertising or public relations No
Legal Profession (Lawyer, Legal Aid)	Legal Profession (Lawyer, Legal Aid) Yes	Legal Profession (Lawyer, Legal Aid) No
Healthcare profession (like doctor or nurse)	Healthcare profession (like doctor or nurse) Yes	Healthcare profession (like doctor or nurse) No
Pharmaceutical or healthcare manufacturing	Pharmaceutical or healthcare manufacturing Yes	Pharmaceutical or healthcare manufacturing No
Health insurance	Health insurance Yes	Health insurance No

*
10. Have you been diagnosed by a physician with Asthma?

Have you been diagnosed by a physician with Asthma? Yes

*
11. Have you been diagnosed by a physician with Chronic obstructive pulmonary disease, sometimes called COPD?

Have you been diagnosed by a physician with Chronic obstructive pulmonary disease, sometimes called COPD? Yes

*
12. Have you been diagnosed by a physician with Diabetes?

Have you been diagnosed by a physician with Diabetes? Yes

*
13. Have you been diagnosed by a physician with Migraines?

Have you been diagnosed by a physician with Migraines? Yes

1. Health Conditions

*1. Name

*2. Gender

3. Work Phone Number

4. Cell Phone Number

*5. Best contact number between the hours of 9am-7pm

*6. Age