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  1. Surveys
  2. 2005
  3. September
  4. S
  5. Sample Survey
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Hello:

You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
How familiar are you with [PRODUCT]?
 
Never heard of it
 
I am aware but have never used it
 
Use it only sometimes
 
Use it on a regular basis
 
 
 
How did you first hear about [PRODUCT]?
 
TV
 
Radio
 
Magazine
 
Newspaper
 
Internet
 
Friend/relative/associate
 
Haven't heard of it before
 
Not sure
 
Other
 
 
 
 
Would you recommend [PRODUCT] to a friend or associate?
 
Definitely Not
 
Probably Not
 
Not sure
 
Probably
 
Definitely
 
 
 
Which community (or rural area) do you live?
   
 
 
 
When making health care decisions for your family, who is the primary decision maker?
 
Male (or husband)
 
Female (or wife)
 
Jointly (both husband and wife)
 
 
 
Sex of person completing this questionnaire:
 
Male
 
Female
 
 
 
Age of person completing this questionnaire:
   
 
 
 
Marital status of person completing this questionnaire:
 
Married
 
Widow(er)
 
Divorced or separated
 
Have never been married
 
Please contact [email protected] if you have any questions regarding this survey.
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