Medical Study - Chicago - Oct. 2016 Question Title * 1. Full Name Question Title * 2. E-Mail Address Question Title * 3. Phone number to reach you Question Title * 4. [OPTIONAL] What is your age? Question Title * 5. What is the highest level of education you have completed? No formal education High school student High school graduate Trade/technical/vocational school College [Bachelor’s Degree] University or above [Master’s or Doctoral Degree] Other (please specify) Question Title * 6. Are you, or is any member of your household, employed by any of the following? An advertising/PR company Marketing or user Research Company Product consultant Media [A newspaper, magazine, TV or radio station] Consultant to a medical/healthcare company Manufacturer of medical products Distributor, retailer or after sale services of medical products Developing and examining department of medical products or packaging design. A company that manufactures, distributes, or sells healthcare products, pharmaceuticals, or medical products. None of the above Question Title * 7. What is your annual household income before taxes? Less than $40,000 $40,001 – $60,000 $60,001 - $80,000 More than $80,000 Question Title * 8. What is your employment status? Full time Part time Student Homemaker Retired In process of looking for a job Next