HIV CAMPAIGN: Get Tested

DOH-Okaloosa HIV Ad Campaign Feedback Form

Question Title

* 1. Location of survey

DOH-Okaloosa

Outreach Area

FDOH-Other County

Question Title

* 2. Are you here because of an ad you saw about HIV Testing? Please let us know where you saw the ad.

Mobile Ad

Social Media: Facebook, Instagram, Youtube, etc.

Radio

Transit Bus

Newspaper ad

Billboard

Cinema advertising

Question Title

* 3. What was the theme of the ad?

Get Tested

I'm Doing It - CDC Get tested campaign

Other (please specify)

Question Title

* 4. Where do you get your news?

Question Title

* 5. What type of music do you listen to?

Question Title

* 6. How much TV do you watch?

A lot

A moderate amount

A little

None at all

Question Title

* 7. If you saw the ad on TV, which station did you see it on?

AMC

BET

ESPN

FOOD NETWORK

MSNBC

MTV

CARTOON NETWORK

VH-1

YOUTUBE

Other (please specify)

Question Title

* 8. What is your music source?

Radio station

Cell phone/internet

Ipod collection

Rarely listen to music

Question Title

* 9. What is your sex?

Male

Female

Other

Question Title

* 10. What is your age range?

18-25

26-35

36-45

46-55

55+