Focus Group Recruitment Questionnaire Survey - COP

Hi:

I am with [MARKET_RESEARCH_COMPANY], a market research company based in [LOCATION]. We are conducting a survey about [SUBJECT] that might be of interest to you. We would like to include your opinions in this study. This is a marketing research study only, and we will not attempt to sell you anything at all today or in the future.

Thank you for your participation

Do you or does any member of your household work for:

An advertising or public relations agency

A market research, strategic marketing or opinion company

The marketing or market research department of any company

A telemarketing firm

A food manufacturer or retailer

A software, hardware or multimedia company

Developer or manufacturer

Online retailer

E-commerce or web development company

Age

Which of the following best describes your age?

Employment

Do you work full time or part time, outside the home?

Full-time [35+ Hours per week]

Part-time [15-20 Hours per week]

Full-time homemaker

Retired

Education

Which of the following best describes the highest level of education completed?

Family Status

Which of the following statements applies to you:

I have children under the age of 6 living at home

I have children between the ages of 6 and 17 living at home

I have no children under the age of 18 living at home

Oral Home Care

a. How many times a day do you brush your teeth?

Once

Twice

Three times or more

b. What brand of toothpaste are you currently using?

c. Are you aware of ingredients in the toothpaste you are currently using that may cause cancer?

Yes

No

d. Which of the following is most important to you when purchasing toothpaste?

Mouthwash

Do you use mouthwash?

Yes

No

If you do use mouthwash, what do you use it for?

Fresh breath

Decrease plaque

Minimize gingivitis

To kill bad bacteria in my mouth

I use it instead of brushing

Other

* Name

Phone

* Email Address

Thank You for completing the Questionnaire... Your honest responses are truly appreciated.

Please click on the Finish Survey button to complete this Survey.