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Survey

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Survey
 
  Are you male or female?  
 
  Male  
  Female  
 
 
  What is your age?  
 
   
 
 
  Are you married, single, divorced or widowed?  
 
  Married  
  Single  
  Divorced  
  Widowed  
 
 
  What search engine do you commonly use?  
 
  Google  
  Yahoo  
  MSN  
  other  
 
 
  What level of education have you obtained?  
 
  High School Diploma  
  2-Year College Degree  
  4-Year College Degree  
  Doctorate, Ph.D. , Master's Degree  
  Other  
 
 
  How many hours a week do you spend on the Internet?  
 
  1-5 Hours  
  5-10 Hours  
  10-20 Hours  
  20+ Hours  
 
 
  What is your favorite hobby or hobbies?  
 
   
 
 
  What magazines do you frequently enjoy reading?  
 
   
 
 
  What other medical or health sites do you read or receive information from?  
 
   
 
 
  What is your computer operating system?  
 
  Windows XP  
  Windows 2000  
  Windows Me  
  Windows 98  
  Windows 95  
  other  
 
 
  Have you used the Internet to purchase any goods or services?  
 
  Yes  
  No  
 
 
  What health problems are you most interested in reading about?  
 
   
 
 
  Do you take a multiple vitamin supplement?  
 
  Yes  
  No  
 
 
  Do you receive any health newsletters by mail?  
 
  Yes  
  No  
 
 
  If you answered yes, please name the newsletters you receive?  
 
   
 
 
  In order to get your name registered for one of the three $25.00 Gift Certificates from Barnes and Noble, please make sure you enter your "first" name and email address below.


We will never share, rent or sell your name. Your privacy is safe with us.

 
  Email:  
  First Name:  
  Last Name:  
 
 
   
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