Research Screening Form

The Voice of Your Customer is recruiting adults to join focus groups for an upcoming research study being held in the Greater Cincinnati Area. Selected participants will be asked to join a three-hour session that will include a group discussion, one-on-one interview, a creative workshop and a lite fare. The sessions will be held at various public buildings in communities throughout the region in 2019. Participants who complete all three parts of the session will receive $150. For more information, contact The Voice of Your Customer at info@thevoiceofyourcustomer.com or 513.281.3228. 

Question Title

* 1. Name

Question Title

* 2. Zip Code

Question Title

* 3. Cell Number - Enter 10 digits (no dashes, periods or parentheses)

Question Title

* 4. Email

Question Title

* 5. Age

Question Title

* 6. Gender

Question Title

* 7. Race

Question Title

* 8. Education

Question Title

* 9. Occupation

Question Title

* 10. Relationship Status

Question Title

* 11. Annual Household Income

Question Title

* 12. Household Size

Question Title

* 13. Do you receive SSI (Supplemental Security Income) or any other disability payments?

Question Title

* 14. Do you have a valid government issued photo ID that confirms your birthdate and zip code?

Question Title

* 15. Would you like to receive notifications about future studies?

Question Title

* 16. In general, how would you describe your health?

Question Title

* 17. In general, how would you describe your stress level?

Question Title

* 18. Do you smoke cigarettes or use tobacco products regularly?

T