Beverages

Hello and thank you for being a part of the Q-insights database.

We are currently inviting people to participate in focus group discussion on shopping habits in Sherman Oaks. The groups will be held on July 25th- 26th.

Upon successful completion you will be compensated $100

If you are interested in participating, please complete the questionnaire below. If you pre-qualify a recruiter will be in touch with you to ask a few additional qualifying questions.

Thank you

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* 1. What is your age?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 2. What is your gender?

Male

Female

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* 3. Which of the following, if any, pertain to you?

	Yes	No
Do you have any food allergies?	Do you have any food allergies? Yes	Do you have any food allergies? No
Do you have any health conditions that limit your diet such as diabetes, etc?	Do you have any health conditions that limit your diet such as diabetes, etc? Yes	Do you have any health conditions that limit your diet such as diabetes, etc? No
Are you lactose intolerant?	Are you lactose intolerant? Yes	Are you lactose intolerant? No
Do you follow a vegan diet?	Do you follow a vegan diet? Yes	Do you follow a vegan diet? No
Do you actively follow a diet such as Paleo, Keto, Weight Watchers, a low carb diet, a low sugar diet, a low-fat diet, and a low-calorie diet, etc.?	Do you actively follow a diet such as Paleo, Keto, Weight Watchers, a low carb diet, a low sugar diet, a low-fat diet, and a low-calorie diet, etc.? Yes	Do you actively follow a diet such as Paleo, Keto, Weight Watchers, a low carb diet, a low sugar diet, a low-fat diet, and a low-calorie diet, etc.? No

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* 4. Have you or anyone in your immediate family ever worked at any of the following companies?

7-Eleven

Banana Republic

Coffee Bean & Tea leaf

Corner Bakery

Costco

Dunkin' Donuts

McDonald’s (Stand alone, or inside another retailer)

Old Navy

Peet's Coffee & Tea

Staples

Starbucks (Stand alone, or inside another retailer)

Target

Walmart

None of these

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* 5. Which of the following specific rewards programs are you....?

	Aware of	Member of	Used in the past 30 days
7-Eleven 7Rewards	7-Eleven 7Rewards Aware of	7-Eleven 7Rewards Member of	7-Eleven 7Rewards Used in the past 30 days
Dunkin Donuts DD Perks Rewards Program	Dunkin Donuts DD Perks Rewards Program Aware of	Dunkin Donuts DD Perks Rewards Program Member of	Dunkin Donuts DD Perks Rewards Program Used in the past 30 days
MyPanera Rewards	MyPanera Rewards Aware of	MyPanera Rewards Member of	MyPanera Rewards Used in the past 30 days
Starbucks Rewards	Starbucks Rewards Aware of	Starbucks Rewards Member of	Starbucks Rewards Used in the past 30 days

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* 6. Which of the following have you visited in the past 30 days to purchased a food or beverage item from each of the following?

7-Eleven

Corner Bakery

Dunkin' Donuts

McDonald's

Panera

Starbucks

Independent Coffee or tea shop

Other (please specify)

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* 7. How often, if at all, do you typically purchase a hot breakfast item for yourself from? (e.g. breakfast sandwiches, egg bites, breakfast wraps or burritos)

	More than once a week	Once a week	2-3 times a month	Once a month	Rarely/Never
7-Eleven	7-Eleven More than once a week	7-Eleven Once a week	7-Eleven 2-3 times a month	7-Eleven Once a month	7-Eleven Rarely/Never
Corner Bakery	Corner Bakery More than once a week	Corner Bakery Once a week	Corner Bakery 2-3 times a month	Corner Bakery Once a month	Corner Bakery Rarely/Never
Dunkin' Donuts	Dunkin' Donuts More than once a week	Dunkin' Donuts Once a week	Dunkin' Donuts 2-3 times a month	Dunkin' Donuts Once a month	Dunkin' Donuts Rarely/Never
McDonald's	McDonald's More than once a week	McDonald's Once a week	McDonald's 2-3 times a month	McDonald's Once a month	McDonald's Rarely/Never
Panera	Panera More than once a week	Panera Once a week	Panera 2-3 times a month	Panera Once a month	Panera Rarely/Never
Startbucks	Startbucks More than once a week	Startbucks Once a week	Startbucks 2-3 times a month	Startbucks Once a month	Startbucks Rarely/Never
Independent Coffee or Tea shop	Independent Coffee or Tea shop More than once a week	Independent Coffee or Tea shop Once a week	Independent Coffee or Tea shop 2-3 times a month	Independent Coffee or Tea shop Once a month	Independent Coffee or Tea shop Rarely/Never
Other	Other More than once a week	Other Once a week	Other 2-3 times a month	Other Once a month	Other Rarely/Never

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* 8. From which of the following would you consider purchasing a food item in the future?

	Yes	No
7-Eleven	7-Eleven Yes	7-Eleven No
Corner Bakery	Corner Bakery Yes	Corner Bakery No
Dunkin'd Donuts	Dunkin'd Donuts Yes	Dunkin'd Donuts No
McDonald's	McDonald's Yes	McDonald's No
Panera	Panera Yes	Panera No
Starbucks	Starbucks Yes	Starbucks No
Independent Coffee or Tea Shop	Independent Coffee or Tea Shop Yes	Independent Coffee or Tea Shop No
Other	Other Yes	Other No

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* 9. Which of the following best describes your attitude toward health and wellness?

I don’t pay attention to my health at all

I care about my health but don't lead a very healthy lifestyle

I lead a fairly healthy lifestyle, but health is not a top priority

I lead a very healthy lifestyle, but it doesn't define me

I lead an incredibly healthy, disciplined lifestyle

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* 10. What is the highest level of education you have completed

Some high school or less

Graduated from high school or equivalent

Attended college or technical school after high school

Graduated from college or technical school

Received post graduated degree

Refused

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* 11. What is your employment status?

Employed full-time outside the home

Employed part-time outside the home

Work full-time from home office

Work part-time from home office

Own your own business

Student

Full-time homemaker

unemployed

Retired

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* 12. What is your marital status?

Single

Married/Living with partner

Divorced/Seperated/Widowed

Refused

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* 13. What is/was your industry or company type?

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* 14. Are you the parent of any children under the age of 17 currently living full time in your household?

Yes

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* 15. What is your ethnic background?

African American or black

Asian

Caucasian or White

Hispanic or latino

Other (please specify)

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* 16. what is your contact info?

Name

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number