Health Insurance

Market Research

Hello,

Thank you for signing up with the Q-insights database.

We are currently conducting a market research study in regards to you, and your families health care providers.

The study will consist of a 5 day online blog sessions between October 23rd and October 28th.

Upon completion of the blogs, you will be compensated $200 for your time as a thank you.

If you are interested, please fill out the questionnaire below.

If you pre-qualify based on this survey, one of our recruiters will contact you.

Question Title

* 1. What is your gender?

Male

Female

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* 2. What is your exact age?

100

Clear

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

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* 3. What state do you currently live in?

State/Province

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* 4. What is your current employment status?

Employed Full-Time

Employed Part-Time

Student

Not Employed

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* 5. Roughly, what is your total household income before taxes?

Less than $10,000 annually

$10,000 to $19,999 annually

$20,000 to $29,999 annually

$30,000 to $39,999 annually

$40,000 to $49,999 annually

$50,000 or greater annually

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* 6. What is your current marital status?

Married and living together

Married, but not living together

Not married, but living with a partner

Divorced and living alone

Single parent, never married

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* 7. Do you have children?

Yes

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* 8. Are you currently pregnant?

Yes

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* 9. Do you have any disability that hampers your ability to care for yourself such as eating, dressing, bathing, toileting or mobility?

Yes

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* 10. Do you or does anyone in your home currently receive Medicaid benefits or have health insurance through ACA/Obamacare?

Yes

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* 11. Please enter your contact information so that one of our recruiters can contact you should you pre-qualify

First Name

Last Name

Email Address

Phone Number