University of Arkansas Sensory Science Center Main Consumer Taste Testing Database Survey

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* 3. At what EMAIL address would you like to be contacted? Make sure this is typed correctly! This is the only way we contact you regarding our studies.

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* 4. What is your phone number?

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* 5. In what year were you born? (enter 4-digit birth year; for example, 1976)

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* 6. What is your gender?

Male

Female

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* 7. How much did your HOUSEHOLD earn last year?

$0 to $19,999

$20,000 to $29,999

$30,000 to $39,999

$40,000 to $49,999

$50,000 to $59,999

$60,000 to $69,999

$70,000 to $79,999

$80,000 to $89,999

$90,000 to $99,999

$100,000 and up

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* 8. What is the highest level of school you have completed or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

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* 9. What is your primary ethnicity?

White or Caucasian

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

Middle Easterner

Latino/Hispanic

Other

Please specify.

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* 10. What is your country of origin?

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* 11. Do you have children under the age of 17 that live in your household?

Yes

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* 12. Do any of these medical conditions apply to you (check all that apply)?

High Blood Pressure

Hypoglycemia

Lactose Intolerance

Diabetes

Food Allergies

Low Vision

Color blindness

Eye disease

Neuronal disease

Mental disorder

Cognitive impairment

Renal disease

Cancer

Hypertension

Liver

Endocrine

Smell loss

Taste loss

Eating disorder

Other

None

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* 13. If you indicated that you have other medical conditions above, please list these conditions:

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* 14. Are you a vegetarian?

Yes

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* 15. Are there any foods you can not eat for health, religious, or allergic reasons:

Yes:
Please list those foods:

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* 16. Do you have a Sams Club membership?

Yes

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* 17. Are you a smoker?

No, I have never been a smoker

No, but I used to smoke

Yes, I am a smoker

University of Arkansas Sensory Science Center Main Consumer Taste Testing Database

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. At what EMAIL address would you like to be contacted? Make sure this is typed correctly! This is the only way we contact you regarding our studies.

Question Title

* 4. What is your phone number?

Question Title

* 5. In what year were you born? (enter 4-digit birth year; for example, 1976)

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* 6. What is your gender?

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* 7. How much did your HOUSEHOLD earn last year?

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* 8. What is the highest level of school you have completed or the highest degree you have received?

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* 9. What is your primary ethnicity?

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* 10. What is your country of origin?

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* 11. Do you have children under the age of 17 that live in your household?

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* 12. Do any of these medical conditions apply to you (check all that apply)?

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* 13. If you indicated that you have other medical conditions above, please list these conditions:

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* 14. Are you a vegetarian?

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* 15. Are there any foods you can not eat for health, religious, or allergic reasons:

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* 16. Do you have a Sams Club membership?

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* 17. Are you a smoker?