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* 1. Contact Information

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* 2. What is your age?

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* 3. Are you the female head of the household?

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* 4. What is your current employment status?

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* 5. Sometimes the type of work people do affects the products they buy. Are you, or is any member of your household employed in any of the following occupations?

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* 6. Are you the primary shopper for baby care products in your household?

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* 7. Is your child age 0 to 48 months in daycare or babysat during the day?

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* 8. Are you a first time mom?

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* 9. Please tell me the age in months, weight and gender of each child aged 0-48 months in your household?

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* 10. Which of the following are you currently using? Select all that apply.

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* 11. What is the diaper size that your baby is currently wearing?

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* 12. What brand of diapers are you currently using? Select all that apply.

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* 13. What brands are you open to using in the future?

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* 14. Does your baby suffer from one of the following skin problems?

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* 15. Our clients like to talk to a variety of people, all in different living situations. Which of the following best describes your household’s total annual household income before taxes?

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* 16. How did you hear about us?

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