36%
Questions marked with a * are required Exit Survey
 
 
A national opinion research firm is conducting a $145.00 PAID OPINION FOCUS GROUP on the topic of HEALTH SERVICES IDEAS taking place EARLY NEXT WEEK.

We have AMPLE SPACES AVAILABLE for MALES & FEMALES AGES 35-85 of ANY ETHNIC BACKGROUND who either 1) have some sort of condition affecting cardio health (high blood pressure, high triglycerides, diabetes, coronary artery disease, stroke, etc) and/or 2) take any prescription medication for cardiovascular health.

Participants will receive $145.00 IMMEDIATELY AT THE END of this 2.5-hour opinion study held in Phoenix (Tempe area JUST OFF THE 202 RED MOUNTAIN & I-10 FREEWAYS). There is EASY FREE PARKING.

There are ample spaces available and there is NO medical documentation needed to qualify for this opinion study, and we have the following times available NEXT MONDAY:

Next Monday October 7th / 1:00PM-3:45PM
Next Monday October 7th / 4:00PM-6:45PM
Next Monday October 7th / 7:00PM-9:45PM

This opinion study is being done on behalf of a MAJOR HEALTH SERVICES PROVIDER, which is looking for honest feedback about a new television and media advertising campaign they will be launching in the next few months in Arizona. 

If interested, please respond to the BRIEF 3-MINUTE SIGNUP QUESTIONS and we will contact you promptly if you qualify.

**This study is strictly for opinion research purposes only. Absolutely no sales involved, no confidential information will be requested whatsoever, you will never become part of a list, and the opinions provided will remain anonymous. **
 
 
 
Participant's First and Last Name
   
 
 
 
Email Address
   
 
 
 
* Best Phone Number(s)
   
 
 
 
What is your gender?
 
Female
 
Male
 
 
 
* What is your current age?
   
 
 
 
What is the highest level of education you have completed?  
 
Some high school or less
 
High school graduate
 
Some college
 
Currently enrolled in college
 
Business, technical or nursing school
 
College graduate
 
Post Graduate
 
 
 
What best describes your ethnic background?
 
Caucasian
 
African-American (Black)
 
Hispanic
 
Asian
 
Native American Indian
 
Some other racial or ethnic group
 
 
 
What type of health insurance coverage do you have?
 
None – I do not have health insurance
 
Through employer or spouse/partner’s employer
 
Individually purchased insurance
 
Medicare
 
Medicaid
 
Military (e.g. TRICARE, VA, CHAMPUS)
 
Other, please specify:
 
 
 
 
Which of the following health conditions (if any) have you experienced?

(SELECT ALL THAT APPLY)
 
1 - High Triglycerides
 
2 - High Bad Cholesterol
 
3 - High Blood Pressure
 
4 - Type 1 Diabetes
 
5 - Type 2 Diabetes
 
6 - Diabetic Retinopathy
 
7 - Renal Impairment
 
8 - Coronary Artery Disease
 
9 - Cerebrovascular, Cartoid Disease
 
10 - Peripheral Artery Disease
 
11 - Obesity
 
12 - Heart Attack
 
13 - Stroke or Mini-Stroke
 
14 - None of the Above