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1. Health and Wellness - June 2011

Thank you for taking the time to answer these brief questions. As always, we appreciate your input as a valuable Plaza Research respondent. We have a new study on HEALTH AND WELLNESS that you maybe interested in.

Please take note that you are ineligible to participate if you have taken part in any research study in the last 6 months.

We are looking for couples interested in Health and Wellness . This is a 1.5-hour focus group discussion in downtown San Francisco on June 21-June 23. The honorarium is $250.00 per couple if you qualify and participate.

IF you qualify based on the answers provided THEN you will receive a call back. However due to the popularity of our surveys and groups, we can't contact everyone.

Please note that all responses will be returned on a first come, first served basis until the studies are full.

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* 1. Contact Information

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* 2. Employment Information

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* 3. What is your gender?

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* 4. Which of the following groups best fits your age?

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* 5. Which of the following groups best fits your partner's age?

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* 6. What is your current employment status?

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* 7. What is your partner's current employment status?

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* 8. So we can get a representative mix, how would you describe your ethnic background?

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* 9. So we can get a representative mix, how would you describe your partner's ethnic background?

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* 10. What’s your highest level of education?

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* 11. Which of the following best describes your household income?

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* 12. Which of the following best describes your relationship status?

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* 13. Please indicate which of the following sleep disorders you or your partner experience on a regular basis?

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