SurveyMonkey Powered Online Survey

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* 1. This survey is being conducted by Adler Weiner Research in order to determine your eligibility for a focus group or interview about which you have been contacted. At no point are your individual answers ever sold or shared with our clients (aggregate data or anonymized summaries of the overall survey information may possibly be shared with our clients, however). This survey serves solely as a means for screening. Once the project has been completed this data will be deleted. For more information please see:
Right to Opt-Out Info
Financial Incentive Info
Adler Weiner Privacy Policy

I consent to Adler Weiner Research collecting, storing and processing my personal information for the purpose of determining my eligibility for this market research focus group or interview.

I understand and consent to the following: That should I be eligible for participation in this market research focus group or interview, my contact information (phone, email, and home address) may be shared with the client for purposes related only to this particular project and are not limited to: screening calls to further determine eligibility, sending of "homework" or pre-session assignments via email, allowing access to an online platform via email, or for in-home interviews conducted at your residence.

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* 2. FOR IN PERSON RESEARCH:
In order to gain admittance to the facility, you need to bring:

A Photo ID

Reading glasses if you need them

Please make sure to self assess your health prior to the session and we ask that you cancel in advance if you are sick with Cold/Flu/Covid-19 symptoms.

Frequently we do not allow cell phones, smart watches, cameras or any electronic/digital devices into the research. There is a possiblity you will be asked to leave your devices with our front desk team where they will be kept securely during the research.

If qualified and based on these participation requirements, are you willing to participate in this in-person interview?

Yes

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* 3. Please fill in the following

Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 4. Which gender identity do you most identify with?

Male

Female

Non-binary

Other (please specify)

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* 5. To which age group do you belong?

Under 18

18-24

25-29

30-34

35-39

40-45

46-55

Over 55

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* 6. What is your exact age?

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* 7. Which of the following best describes your racial or ethnic background?

Hispanic or Latino (Spanish, Mexican, Latin America: Colombian, Brazilian, etc., Caribbean: Cuban, Puerto Rican, Dominican, etc.)

White European (e.g. German, Irish, English, Italian)

Middle Eastern or North African (e.g. Lebanese, Turkish, Egyptian)

Black American or of African Descent (e.g. Jamaican, Haitian, Nigerian, Ethiopian, Somali)

Asian (e.g. Chinese, Taiwanese, Korean, Japanese, Vietnamese, Indian, Indonesian, Filipino, Thai)

Native Hawaiian or other Pacific islander (e.g. Samoan, Chamorro, Tongan, Fijian)

Native American, Inuit, or Aleut (e.g. Navajo Nation, Nome Eskimo Community, Cherokee)

Other (please specify)

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* 8. Are you or is any member of your immediate family currently employed in any of the following types of business? Check all that apply

An advertising, marketing, marketing research or public relations firm

A newspaper, magazine, book publisher, blog or website

A food or beverage manufacturer, packer, processor, wholesaler, or distributor

A restaurant, café, coffee shop or food services company

None of the above

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* 9. Have you participated in any market research that took more than 15 minutes in the past 6 months?

Yes

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* 10. Are you the parent or legal guardian of any children aged 17 years or younger who lives in your household?

Yes

No children age 17 years or younger

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* 11. Which of the following, if any, pertain to you?

	Yes	No
Do you have any food allergies?	Do you have any food allergies? Yes	Do you have any food allergies? No
Do you have any health conditions that limit your diet such as diabetes, high cholesterol, etc.?	Do you have any health conditions that limit your diet such as diabetes, high cholesterol, etc.? Yes	Do you have any health conditions that limit your diet such as diabetes, high cholesterol, etc.? No
Are you lactose intolerant?	Are you lactose intolerant? Yes	Are you lactose intolerant? No
Do you follow a Vegetarian diet?	Do you follow a Vegetarian diet? Yes	Do you follow a Vegetarian diet? No
Do you follow a Vegan Diet?	Do you follow a Vegan Diet? Yes	Do you follow a Vegan Diet? No
Are you currently observing any diet for a religious holiday?	Are you currently observing any diet for a religious holiday? Yes	Are you currently observing any diet for a religious holiday? No
Do you actively follow a low sugar diet?	Do you actively follow a low sugar diet? Yes	Do you actively follow a low sugar diet? No
Do you actively follow a diet such as Paleo, Keto, Weight Watchers, a low carb diet, a low-fat diet, and a low-calorie diet, etc.?	Do you actively follow a diet such as Paleo, Keto, Weight Watchers, a low carb diet, a low-fat diet, and a low-calorie diet, etc.? Yes	Do you actively follow a diet such as Paleo, Keto, Weight Watchers, a low carb diet, a low-fat diet, and a low-calorie diet, etc.? No

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* 12. Please tell me what you think of each of the following brands.

	Love it	Like it	It’s Okay	Don’t like it much	Don’t like it at all	Not aware of
McDonald’s	McDonald’s Love it	McDonald’s Like it	McDonald’s It’s Okay	McDonald’s Don’t like it much	McDonald’s Don’t like it at all	McDonald’s Not aware of
Starbucks	Starbucks Love it	Starbucks Like it	Starbucks It’s Okay	Starbucks Don’t like it much	Starbucks Don’t like it at all	Starbucks Not aware of
Dunkin’	Dunkin’ Love it	Dunkin’ Like it	Dunkin’ It’s Okay	Dunkin’ Don’t like it much	Dunkin’ Don’t like it at all	Dunkin’ Not aware of
7-Eleven	7-Eleven Love it	7-Eleven Like it	7-Eleven It’s Okay	7-Eleven Don’t like it much	7-Eleven Don’t like it at all	7-Eleven Not aware of
Panera Bread	Panera Bread Love it	Panera Bread Like it	Panera Bread It’s Okay	Panera Bread Don’t like it much	Panera Bread Don’t like it at all	Panera Bread Not aware of
Coffee Bean & Tea Leaf	Coffee Bean & Tea Leaf Love it	Coffee Bean & Tea Leaf Like it	Coffee Bean & Tea Leaf It’s Okay	Coffee Bean & Tea Leaf Don’t like it much	Coffee Bean & Tea Leaf Don’t like it at all	Coffee Bean & Tea Leaf Not aware of

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* 13. Have you purchased and drank beverages from any of the following in the last 30 days? Check all that apply

Starbucks

McDonald’s

Dunkin’

7-Eleven

Panera Bread

Coffee Bean & Tea Leaf

None of the above