Autism Spectrum Disorder (ASD) (MR)

Autism Spectrum Disorder Respondents

We are a branch of a larger market research company, whose goal is to make contact with as many caregivers of people diagnosed or involved in the treatment of Autism Spectrum Disorder. We will be looking to reach out to those interested in the form of online surveys and telephone discussions to further understand the needs of autism patients and caregivers. When contacted and qualified we will pay respondents for their time (up to $100).

All information collected during the surveys or phone discussions will be completely confidential in that your name or any other identifying information will not be shown to our clients.

Question Title

* 1. Are you the individual diagnosed with Autism or the caregiver?

Caregiver

Diagnosed Individual

Question Title

* 2. Please note age of when individual was diagnosed?

0 - 3 years

4 - 6 years

7 - 12 years

>12 years

Do not know

Question Title

* 3. Is the individual diagnosed with Autism a

Male

Female

Prefer not to answer

Question Title

* 4. Please provide contact information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number