Demo Survey Form
 

Sample survey topic: Seafood
Number of questions in survey: 18 questions
Payment upon completion of survey: $8.00 U.S.
Estimated time to complete survey: 5-10 minutes

Contact Information:

Name:

Mailing address:

City

State

Zip:

E-mail address:

   
   

What is your gender?

Male
Female
   

What age group do you fall into?

18-26
27-34
35-44
45-54
55 or older
   

Have you shopped for any seafood in the last 6 months?

Yes
No
   

What types of seafood have you shopped for in last 6 months?
 

Fish
Lobster
Crab
Shrimp
other  
   

What type of store do you normally purchase your seafood at?

Supermarket
Albertsons
Kroger
Ralph's Wholesale club
Cotsco
Sam's club
BJ's Supercenter
Super-walmart
Super-Target Local seafood store
   

Was the seafood displayed on ice at the store?

Yes
No
   

Were there a variety of brands to choose from?

Yes
No
   

Was the seafood section clean and in order?

Yes
No
   

Was there someone in the department to assist you if you needed help?

Yes
No
   

How much do you normally spend on seafood at one time?

Less than $10
$11-$15
$16-$20
$21-$25
More than $26
   

Did you find the stores prices to be reasonable?

Yes
No
   

What is most important to you when purchasing seafood?

Variety
Color
Price
Quality
   

What would be your second issue of importance when purchasing sefood?

Variety
Color
Price
Quality
   

Have you ever heard of a seafood product that was " cholesterol free "?

Yes
No
   

Would you consider trying a product like this?

Yes
No
   

How many times a month do you shop for seafood?

Once a month
2-4 times a month
5-7 times a month
More than 7 times a month
   

If you had only one choice of food to eat every day for a week- Would you choose:

Seafood
Meat
Vegetables
Grains ( i.e. breads, cereals )
   

How often do you eat seafood ?

1-3 days a month
Once a week
2-4 days a week
Every day
   

Thank you for taking the time to participate in our seafood survey. Please click on the submit button below to complete and send us your survey.

 

   

Note: This is a sample of what a typical survey would look like. You will not be paid for taking this survey. Actual surveys may be shorter or longer than this one.


 



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