Home Health and Wellness Study #4092

Question Title

* 1. Contact Information

First Name

Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. What is your age?

Question Title

* 3. What is your DOB?

Month/Day/Year

Date

Question Title

* 4. What is your gender?

Male

Non-Binary

Female

Prefer to self-describe

Question Title

* 5. What is your ethnicity? (Select all that apply)

African-American

Asian-American

Hispanic/Latino-American

Indian-American

Native American

White American

Multi-racial

Prefer to self-identify (please specify)

Question Title

* 6. Do you or does any member of your household work in any of the following fields?

Advertising, public relations or market research

Retail – Grocery, Clothing, Department, Technology

Retail – Home Improvement, Plumbing, Hardware

Home Construction/repair/remodel/plumber/ contractors

Wholesale/retail manufacturer of plumbing fixtures (any type)

Government

Education (all levels)

Hotel industry

None of the above

Do not know

Question Title

* 7. Which of the following best describes your current living situation?

Own a single-family home

Rent a single-family home

Own a townhome

Rent a townhome

Own a condo

Rent a condo

Rent an apartment

None of the above

Other (please specify)

Question Title

* 8. Which category includes your annual household income from all sources, but before taxes?

Less than $20,000

$20,000 to just under $40,000

$40,000 to just under $50,000

$50,000 to just under $70,000

$70,000 to just under $100,000

$100,000 to just under $150,000

$150,000 to just under $200,000

$200K plus

Question Title

* 9. Are you currently…?

Self-employed

Employed full-time

Employed part-time

Retired

A student

None of the above

Question Title

* 10. What is your occupation?

Question Title

* 11. Which, if any of the following items have you purchased for your home in the past 2 years?

Washer or Dryer

Kitchen Cabinets

Kitchen Sink Faucet

Showerhead

Bathroom sink faucet

Bathroom cabinets

Toilet

Lawn mower

Car

Computer

None of the above

Question Title

* 12. And which, if any are you considering purchasing in the next 12 months?

Washer or Dryer

Kitchen Cabinets

Kitchen Sink Faucet

Showerhead

Bathroom sink faucet

Bathroom cabinets

Toilet

Lawn mower

Car

Computer

None of the above

Question Title

* 13. When deciding to purchase a home plumbing fixture such as a faucet, showerhead or toilet is the decision… ?

Made primarily by you

Shared equally by you and other members of your household

Made primarily by another member of your household

None of the above