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1.
This survey is being conducted by Adler Weiner Research in order to determine your eligibility for a focus group or interview about which you have been contacted. At no point are your individual answers ever sold or shared with our clients (aggregate data or anonymized summaries of the overall survey information may possibly be shared with our clients, however). This survey serves solely as a means for screening. Once the project has been completed this data will be deleted. For more information please see:
Right to Opt-Out Info
Financial Incentive Info
Adler Weiner Privacy Policy
(Required.)
I consent to Adler Weiner Research collecting, storing and processing my personal information for the purpose of determining my eligibility for this market research focus group or interview.
I understand and consent to the following: That should I be eligible for participation in this market research focus group or interview, my contact information (phone, email, and home address) may be shared with the client for purposes related only to this particular project and are not limited to: screening calls to further determine eligibility, sending of "homework" or pre-session assignments via email, allowing access to an online platform via email, or for in-home interviews conducted at your residence.
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2.
FOR IN PERSON RESEARCH:
In order to gain admittance to the facility, you need to bring:
A Photo ID
Reading glasses if you need them
Please make sure to self assess your health prior to the session and we ask that you cancel in advance if you are sick with Cold/Flu/Covid-19 symptoms.
Frequently we do not allow cell phones, smart watches, cameras or any electronic/digital devices into the research. There is a possiblity you will be asked to leave your devices with our front desk team where they will be kept securely during the research.
If qualified and based on these participation requirements, are you willing to participate in this in-person interview?
(Required.)
Yes
No
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3.
Please fill in the following
(Required.)
Name (First and last)
Address
City
Zipcode
Phone
Email
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4.
With which gender do you identify?
(Required.)
Male
Female
Non-binary
Other (please specify)
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5.
With which ethnicity do you identify? Please check all that apply
(Required.)
White
Black or African American
Hispanic or Latino
Asian or Asian American
Other (please specify)
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6.
To which age group do you belong?
(Required.)
Under 18
18-24
25-34
35-44
45-54
Over 54
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7.
What is your exact age?
(Required.)
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8.
Research companies are particularly interested in knowing if people have some relationship with or knowledge about certain occupations. Think about the job(s) and occupations you and members of your family, close friends and relatives hold. Do any have jobs that are in the following types of companies or have related job titles: Check all that apply
(Required.)
Manufacturer, retailer or wholesaler of food or beverage products
Dietician, personal trainer or any sports related industry
A grocery, mass merchandise or club store
Marketing or market research
Advertising agency or public relations
Television, radio, magazine, or newspaper
Direct mail or promotional agency
Graphic design or art
None of the above
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9.
Are you employed:
(Required.)
Full-time
Part-time
Stay-at-home parent
not employed or If you're a student and not working
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10.
Please tell me you Job Title, Company Name and Industry
(Required.)
Job Title
Company Name
Industry
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11.
If there is any other working person in the household -who is it (spouse, parent child or other adult) what is their Job Title, Company Name and Industry (If there isn't put N/A)
(Required.)
Who
Job 'title
Company Name
Industry
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12.
Do you have any children under 18 years old in the household?
(Required.)
Yes
No
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13.
When was the last time you participated in a market research discussion or a one-on-one interview about products or services?
(Required.)
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14.
What was/were the subject(s) of the discussion(s) in which you have participated?
(Required.)
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15.
Please answer the following questions about your health and diet
(Required.)
Yes
No
Are you on a special medical diet?
Yes
No
Are you allergic or sensitive to any foods or food ingredients?
Yes
No
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16.
How often do you exercise, work-out, practice, train for or play sports?
(Required.)
Daily
4-6 times per week
3 times per week
2 times per week
1 times per week
Less often than 1 day per week
