Survey

*
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. When was the last time you participated in a research focus group or one on one interview?

When was the last time you participated in a research focus group or one on one interview? Less than 3 months ago

3-6 months ago

6-12 months ago

More than 1 year ago

Never

10. Do you, or any of your family or close friends work in any of the following occupations?

	Yes	No
Advertising	*Do you, or any of your family or close friends work in any of the following occupations? Advertising Yes	Advertising No
Market Research / Marketing	Market Research / Marketing Yes	Market Research / Marketing No
Public Relations	Public Relations Yes	Public Relations No
Media (including TV & Journalism)	Media (including TV & Journalism) Yes	Media (including TV & Journalism) No
Pharmaceutical or Biotechnology	Pharmaceutical or Biotechnology Yes	Pharmaceutical or Biotechnology No
Medicine (including Physician, Pharmacist, or Nurse)	Medicine (including Physician, Pharmacist, or Nurse) Yes	Medicine (including Physician, Pharmacist, or Nurse) No
National or State Healthcare Regulatory Agency	National or State Healthcare Regulatory Agency Yes	National or State Healthcare Regulatory Agency No

*
11. Has your doctor told you that you have arthritis?

Has your doctor told you that you have arthritis? Yes

*
12. Has your doctor told you that you have diabetes?

Has your doctor told you that you have diabetes? Yes

*
13. Has your doctor told you that you have shingles?

Has your doctor told you that you have shingles? Yes

1. Health Issues

*1. Name

*2. Gender