Walker Research

Respondent Form

Respondent FormThank you for your interest in becoming a participant in consumer research and focus group studies. Our first step is to gather some basic information from you regarding product usage. Below is a list of questions that will only take minutes to answer. Our focus group facility is located on 6910 North Shadeland Avenue. The information collected will only be used by Walker Research and will not be given out to any third parties.  When a study comes up that you potentially qualify for, you will be contacted.  Please feel free to share this with anyone who you might think will be interested in future studies.  Until then, thank you, once again, for your interest in our studies. Your opinions are important to us!

If you have any questions please email us at focusgroup@walkerinfo.com.

Male Female
County:
Township:
Which of the following best describes your current residence? Apartment
Condominium
Duplex
House
Mobile Home
Townhome
Other (Please specify)
Ethnic Background:
(mark all that apply)





(Please specify)
Married
Single
Divorced
Separated
Widowed

Less than HS Grad
High Grad
Some College
Tech School
College Grad
Graduate Degree

Own
Rent
Live with Parents
Other (Please specify)
Under $20,000
$20,000 - 29,999
$30,000 - 39,999
$40,000 - 49,999
$50,000 - 59,999
$60,000 - 69,999
$70,000 - 79,999
$80,000 - 99,999
$100,000 - 149,999
Over $150,000
Full Time
Part Time
Not Employed
Retired






Which of the following, if any, do you suffer from?





           
           
                





Which of the following products do you use on a regular basis?









What brand of the following, if any, do you use most often?
  Is that . . .
Pets
      
      
What brands of the following, if any, do you own?

Who, if anyone supplies the following?





Submit

 

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Contact Us

Call us today to consider our full range of research services.

Barb Miller
317.806.2701
bmiller@walkerinfo.com

Interested in participating in one of our focus groups?
E-mail us for more information (focusgroup@walkerinfo.com), or click here to fill out a form.