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Calhoun Law 2024 Personal Injury Focus Group Initial Survey
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1.
What is your legal name?
(Required.)
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2.
What city and state do you currently live in?
(Required.)
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3.
What is your cell phone number? (Ex. XXX-XXX-XXXX)
(Required.)
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4.
What is your email address?
(Required.)
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5.
What is your ethnicity/race?
(Required.)
American Indian
Asian
Black of African American
Hispanic of Latino
White or Caucasian
Other (please specify)
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6.
Select the age range that you belong to below:
(Required.)
18-20 years old
21-30 years old
31-40 years old
41-50 years old
51-60 years old
61-69 years old
Over 70 years old
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7.
What is your political affiliation?
(Required.)
Democrat
Republican
Libertarian
Democratic Socialist
Independent
Other
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8.
What is/was your occupation - or your desired occupation if not currently employed:
(Required.)
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9.
What is your total household income?
(Required.)
$0 - $40,000
$40,001 - $75,000
$75,001 - $100,000
Over $100,000
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10.
Have you ever served on a jury?
(Required.)
Yes
No
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11.
Do you have anything that would prevent you from sitting and participating in this focus group for its scheduled time?
(Required.)
Yes
No
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12.
What is your marital status?
(Required.)
Never Married
Married
Divorced
Divorced and Remarried
Living with Partner
Widowed
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13.
Do you have children?
(Required.)
Yes
No
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14.
What is the highest level of education you completed?
(Required.)
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15.
Are you currently employed?
(Required.)
Yes
No
Retired
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16.
How important is religion in your life?
(Required.)
It is the most important thing
Very important
Moderately important
Somewhat important
Slightly important
Not important
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17.
Have you ever been a party in a lawsuit other than a divorce?
(Required.)
Yes
No
18.
If you have been involved in a lawsuit, please check all that apply:
I brought a suit for personal injuries
I was sued regarding an auto accident
I brought a suit over a contract
I was sued over a contract
I was involved in a suit over a business or employment
Other (please specify)
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19.
Have you ever participated in a focus group?
(Required.)
Yes
No
