Copy of In Home Opinion Study = $700

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* 1. Contact Info

Name

Phone

E-Mail

City, State

Zip Code

Age

Gender

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* 2. This is an in home study - do you agree to have our researchers come to your home for up to 3 hours?

Everyone will be vaccinated wearing N95 masks and will follow all covid protocol.

Yes

No

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* 3. This study requires that another adult from your household or a friend be present for the entire interview - both of you will be interviewed. NO ONE ELSE OTHER THAN THE TWO OF YOU CAN BE PRESENT IN THE HOME. They can not stay in a bedroom, the basement, the attic or any room in the house while the interview is being conducted. Children can not be present as well - JUST THE TWO OF YOU

Are you still interested in participating with this study requirement?

Yes

No

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* 4. Are either you or another member of your household/friend willing to:

	yes	no
Do Various tasks Such as Stand, Sit, Walk Around House	Do Various tasks Such as Stand, Sit, Walk Around House yes	Do Various tasks Such as Stand, Sit, Walk Around House no
Wear Long Sleeves or Sweater	Wear Long Sleeves or Sweater yes	Wear Long Sleeves or Sweater no
Wear Props Such as Rings, Bracelets, Temp Tattoos	Wear Props Such as Rings, Bracelets, Temp Tattoos yes	Wear Props Such as Rings, Bracelets, Temp Tattoos no
Sit in Dim or Low Light	Sit in Dim or Low Light yes	Sit in Dim or Low Light no

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* 5. Are you and the other member of your inner circle/household willing to wear a mask for the duration of the study (with breaks as needed)?

Yes

No

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* 6. Do you have a pet?

Cat

Dog

No Pets

Other (please specify)

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* 7. THIS IS NOT REQUIRED - BUT WE HAVE QUOTAS FOR 13-20 YR OLDS IN OUR PROJECT = Do you have an 13-20 year old that can participate in this study with you?

Yes, 13-17

Yes, 18-20

No