*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.

*2.CONTACT INFO Please provide the following:(Required.)

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

*3.Do you or does anyone in your immediate family work (currently or in the past) for any of the following?(Required.)

A marketing or market research firm or department

An advertising or public relations firm

A marketing or marketing research consultancy

Any kind of media company – a TV or radio station or newspaper or magazine

An insurance company

None of the above

*4.What is your gender?(Required.)

Male

Female

Trans Female/Trans Woman

Trans Male/Trans Man

Genderqueer, Gender Non-conforming, or Nonbinary Gender

*5.What is your age range?(Required.)

18-24

25-44

45-55

56-60

61 +

*6.Which of the following best describes your current housing situation?(Required.)

I own my home/condo

I rent a home/condo/apartment

I live with family or friends and do not pay rent

I live in student housing

I live in a retirement or assisted living community

Other (please specify)

*7.Where in the country do you live?(Required.)

Southern CA

Northern CA

West outside of CA

Illinois

Midwest outside of Illinois

South

East

Northeast

*8.Have you ever participated in a market research study where you’ve been asked to discuss your opinions of products or services before?(Required.)

Yes

No

*9.When was the last time, if ever, you participated in a market research discussion or a one-on-one interview about insurance products?(Required.)

I have never participated in a study about insurance

Within the past three months

Within the past three to six months

More than six months ago

*10.Which of the following best describes your involvement in household decisions when choosing insurance or other financial products and services?(Required.)

I act as the primary decision maker

I am heavily involved, shared decision maker

I am somewhat involved, shared decision maker

I am not involved