You and Your Health – Focus Force

Thank you for registering your interest in this new research on behalf of a Leading Health Organisation.

This leading and innovative research will give you the opportunity to have your say on remedies and health products

The research is in the form of a 2.5hrs session plus a 15 minutes pre-task and a 20 minutes call (post session) and is taking place on Wednesday the 9th, Thursday the 10th or Friday 11th December 2015 .

Not only will you be given the opportunity to feedback and have your say with leading health practices we are offering a £80 - £110 incentive for your time!

You will receive £110 if you participate in a daytime groupe
You will receive £80 if you participate in an evening group

Details as follows:

Date – Wednesday the 9th, Thursday 10th or Friday the 11th of December 2015
Times - Afternoon/evening
Location - London
Type of research - Focus Group + follow up phone interview

When completing the form please answer carefully and as honestly as possible, there are no right or wrong answers, all answers will be looked at individually when checking that you are applicable for the research.

If you do fit the profile of respondent that we are looking for, then one of our team will call you to book you in.

Scheduling

Your Contact Details

Your Current Life Stage...

Your Employment...

Your Role...

SCREENING: Current & Past Employment

SCREENING: Past Research

You and your health...

Do you regularly or occasionally suffer from any of the following medical problems? *
How do you usually deal with your acid-related stomach problems? Which of the following do you do to ease your suffering?
Which of the following brands have you used in the past 12 months?
Which of the following brands have you use most often?
Which of the following brands would you never use?

SCREENING: Suitability

Please indicate the date(s) and time(s) you are currently available for? *
Please indicate all that apply

This information will be held confidentially and securely by Roots Research Ltd in accordance with the Data Protection Act 1998 and Market Research Society Code of Conduct.

I understand that my information will only be used to provide me with the opportunity to participate in occasional paid research. I am aware that I am under no obligation to participate and I am entitled to have my data removed at any point. *
Sending
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