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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
Address
City/Town
ZIP/Postal Code
Email Address
Phone Number
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4.
Which gender identity do you most identify with?
(Required.)
Male
Female
Non-binary
Other (please specify)
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5.
To which age group do you belong?
(Required.)
Under 18
18-24
25-29
30-34
35-39
40-45
46-55
Over 55
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6.
What is your exact age?
(Required.)
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7.
Which of the following best describes your racial or ethnic background?
(Required.)
Hispanic or Latino (Spanish, Mexican, Latin America: Colombian, Brazilian, etc., Caribbean: Cuban, Puerto Rican, Dominican, etc.)
White European (e.g. German, Irish, English, Italian)
Middle Eastern or North African (e.g. Lebanese, Turkish, Egyptian)
Black American or of African Descent (e.g. Jamaican, Haitian, Nigerian, Ethiopian, Somali)
Asian (e.g. Chinese, Taiwanese, Korean, Japanese, Vietnamese, Indian, Indonesian, Filipino, Thai)
Native Hawaiian or other Pacific islander (e.g. Samoan, Chamorro, Tongan, Fijian)
Native American, Inuit, or Aleut (e.g. Navajo Nation, Nome Eskimo Community, Cherokee)
Other (please specify)
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8.
Are you or is any member of your immediate family currently employed in any of the following types of business? Check all that apply
(Required.)
An advertising, marketing, marketing research or public relations firm
A newspaper, magazine, book publisher, blog or website
A food or beverage manufacturer, packer, processor, wholesaler, or distributor
A restaurant, café, coffee shop or food services company
None of the above
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9.
Have you participated in any market research that took more than 15 minutes in the past 6 months?
(Required.)
Yes
No
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10.
Are you the parent or legal guardian of any children aged 17 years or younger who lives in your household?
(Required.)
Yes
No children age 17 years or younger
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11.
Which of the following, if any, pertain to you?
(Required.)
Yes
No
Do you have any food allergies?
Yes
No
Do you have any health conditions that limit your diet such as diabetes, high cholesterol, etc.?
Yes
No
Are you lactose intolerant?
Yes
No
Do you follow a Vegetarian diet?
Yes
No
Do you follow a Vegan Diet?
Yes
No
Are you currently observing any diet for a religious holiday?
Yes
No
Do you actively follow a low sugar diet?
Yes
No
Do you actively follow a diet such as Paleo, Keto, Weight Watchers, a low carb diet, a low-fat diet, and a low-calorie diet, etc.?
Yes
No
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12.
Please tell me what you think of each of the following brands.
(Required.)
Love it
Like it
It’s Okay
Don’t like it much
Don’t like it at all
Not aware of
McDonald’s
Love it
Like it
It’s Okay
Don’t like it much
Don’t like it at all
Not aware of
Starbucks
Love it
Like it
It’s Okay
Don’t like it much
Don’t like it at all
Not aware of
Dunkin’
Love it
Like it
It’s Okay
Don’t like it much
Don’t like it at all
Not aware of
7-Eleven
Love it
Like it
It’s Okay
Don’t like it much
Don’t like it at all
Not aware of
Panera Bread
Love it
Like it
It’s Okay
Don’t like it much
Don’t like it at all
Not aware of
Coffee Bean & Tea Leaf
Love it
Like it
It’s Okay
Don’t like it much
Don’t like it at all
Not aware of
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13.
Have you purchased and drank beverages from any of the following in the last 30 days? Check all that apply
(Required.)
Starbucks
McDonald’s
Dunkin’
7-Eleven
Panera Bread
Coffee Bean & Tea Leaf
None of the above
