Sample Survey

Sample Survey

Sample Survey


 

This is a sample survey of what you will be paid to participate in.

Survey Topic: Personal Shopping
Number of Questions: 20
Payment for Completing Survey: $20.00

Name:

Address:

City:

State:

Zip Code:

Email Address:
1. What is your gender?
male

female

2. Which of the following ranges includes your age?
(select one answer)
18-24
25-31
32-40
41 or older

3. Which grocery store do you most frequently shop at?
(select one answer)
Albertsons
Hughes
Ralphs
Safeway
Stater Brothers
Vons
Other (please specify)

4. How often do you shop for groceries per month?
(select one answer)
5 times a month
4 times a month
3 times a month
twice a month
once a month
less often than once month

5. On average, how much money do you spend on groceries in
total per month?
(select one answer)
under $50
$50 to $100
$101 to $200
$201 to $300
$301 to $400
$401 to $500
$501 or more

6. Are online grocery shopping services available in your area?
(select one answer)
Yes
No
Don’t know

7. Have you ever shopped online for groceries?
(select one answer)
Yes
No

8. When you purchase groceries, do you generally…?
(select one answer)
Purchase only items you intended to purchase prior to going
to the grocery store
Purchase additional items that you see while you are browsing
Purchase additional items that you see advertised

9. Have you ever pulled coupons or special offers from newspapers to use when shopping for groceries?
(select one answer)

Yes
No

10. Does the grocery store you visit most frequently offer a frequent shopper program?
(select one answer)
Yes
No

11. How would you rate the customer service at the grocery store you frequently shop at?
(select one answer)
Excellent
Very Good
Average
Poor

12. Which pharmacy/drugstore do you most frequently shop at?
(select one answer)
Longs
Osco
Rite Aid
Savon
Walgreen
Other (Please specify)

13. How often do you shop for pharmacy/drugstore products per month?
(select one answer)
5 times a month
4 times a month
3 times a month
twice a month
once a month
less often than once month

14. On average, how much money do you spend on pharmacy/drugstore products in
total per month?
(select one answer)
under $50
$50 to $100
$101 to $200
$201 to $300
$301 to $400
$401 to $500
$501 or more

15. Are online pharmacy/drugstore services available in your area?
(select one answer)
Yes
No
Don’t know

16. Have you ever shopped online for pharmacy/drugstore products?
(select one answer)
Yes
No

17. When you purchase pharmacy/drugstore products, do you generally…?
(select one answer)
Purchase only items you intended to purchase prior to going
to the grocery store

Purchase additional items that you see while you are browsing
Purchase additional items that you see advertised

18. Have you ever pulled coupons or special offers from newspapers to use when shopping for pharmacy/drugstore products?
(select one answer)

Yes
No

19. Does the pharmacy/drugstore you visit most frequently offer a frequent shopper program?
(select one answer)
Yes
No

20. How would you rate the customer service at the pharmacy/drugstrore you frequently shop at?
(select one answer)
Excellent
Very Good
Average
Poor

Thank you for taking the time to participate in our survey about personal shopping.

2017-03-09T23:54:06+00:00 By |