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Alcohol Testing - Acrobat (309298)
1.
Address
Name
Email Address
Phone Number
*
2.
Occupation
(Required.)
*
3.
QQ1. Are you…
(Required.)
Male
Female
*
4.
QQ2. And how old are you…?
(Required.)
*
5.
QQ3. We are looking for people who work in certain occupations. Can you please tell me if you or any member of your household, relatives or close friends work in any of these professions or industries?
(Required.)
Advertising/sales promotion/design
Journalism
Marketing/market research
New product development
Public relations
Manufacture or sale of alcohol
TV/Radio/Press
None of these
*
6.
QQ4.Have you participated in any market research studies in the last three months?
(Required.)
Yes
No
*
7.
QQ5. Are you currently pregnant or breastfeeding?
(Required.)
Yes
No
*
8.
QQ6. Which of the following types of beverages do you regularly drink?
(Required.)
Alcoholic Beverages
Fruit Juices
Smoothies
Milkshakes
Hot Drinks
Energy Drinks
Soft Fizzy Drinks (Coke, Pepsi etc)
Other (please specify)
*
9.
QQ7. Do you have any allergies / intolerances related to alcohol?
(Required.)
Yes
No
*
10.
Which of the following alcoholic beverages do you regularly drink at a pub/bar/club/restaurant?
(Required.)
Beer
Non-alcoholic Beer
Wine
Liquors (e.g. fruit, cream, herbal)
Vodka
Whisky
Rum
Gin
Tequila
Other
None of the above
*
11.
Which of the following alcoholic beverages do you regularly drink
at home
?
(Required.)
Beer
Non-alcoholic Beer
Wine
Liquors (e.g. fruit, cream, herbal)
Vodka
Whisky
Rum
Gin
Tequila
Other
None of the above
*
12.
QQ9a. Which of the following brands of beer have you drank in the last 3 months?
(Required.)
Guinness Draught
Heineken lager
Coors Light
Carlsberg lager
Budweiser lager
Smithwick’s Ale
Carling lager
Corona
Tennents lager
Hop House 13
Rockshore lager
Foster’s
Peroni
Stella Artois
John Smith’s
San Miguel
Amstel
Other
None of the above
Would consider all
*
13.
QQ9b. Which of the following brands of beer do you regularly drink?
(Required.)
Guinness Draught
Heineken lager
Coors Light
Carlsberg lager
Budweiser lager
Smithwick’s Ale
Carling lager
Corona
Tennents lager
Hop House 13
Rockshore lager
Foster’s
Peroni
Stella Artois
John Smith’s
San Miguel
Amstel
Other
None of the above
Would consider all
*
14.
QQ9d. Which of the following brands of beer would you NEVER consider?
(Required.)
Guinness Draught
Heineken lager
Coors Light
Carlsberg lager
Budweiser lager
Smithwick’s Ale
Carling lager
Corona
Tennents lager
Hop House 13
Rockshore lager
Foster’s
Peroni
Stella Artois
John Smith’s
San Miguel
Amstel
Other
None of the above
Would consider all
15.
QQ10a.Which of the below statements best applies to you?
I never consider things like sugar content or calories when I’m drinking alcohol
I sometimes consider things like sugar content or calories when I’m drinking alcohol
I often consider things like sugar content or calories when I’m drinking alcohol
16.
Do you confirm that you will not drive home after this test?
Yes
No
17.
Do you confirm that you will regulate your alcohol intake over the period of this research to not exceed the recommended weekly alcohol intake of no more than 14 units per week?
Yes
No
18.
What time slots are you available for? (please note we will contact you to confirm)
4.30pm
5pm
5.30pm
6pm
6.30pm
7pm
7.30pm
19.
Recruiters Name
20.
We are looking for people to take part in research about alcoholic beer.
This would involve you attending a 10 minute session at central location . At this session, you will be asked to assess 1 beer and answer some questions about them.
Please note that if you take part in this research you will be required to last the duration of the survey without smoking.
Please bring a valid form of photo ID to be checked at the hall (e.g. passport or driving licence)
Please see www.DrinkIQ.com for more information about responsible drinking.
Are you willing to take part in this research, and available the date specified?
Yes
No
