Plaza Research Chicago is currently looking for people with specific health conditions. Please answer the following questions to see if you meet the specifications we are looking for.

* 1. Contact Information

* 2. Age

* 3. Occupation

* 4. Which of the following medical conditions have you been diagnosed with?

* 5. Do you currently own a car/ vehicle?

* 6. If so, what is the Make, Model and year of the car/ vehicle you own?

* 7. Which of the following do you own and use regularly?

* 8. Employment

* 9. Income

* 10. Ethnicity

Thank you for your time. If you meet the specifications we are looking for someone from Plaza Research will contact you to ask some additional questions and see if you can qualify for these studies.

When you click Done you will be redirected to our Facebook Page. Facebook and Plaza Research are not, in any way, connected. You also do not need to be a Facebook member in order to qualify for the study that you just applied for. This is strictly a convenience if you, our respondent, would like to "like" our page as another avenue to be notified of upcoming groups.

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