Focus Group Questionnaire- 2026 DBL

Focus Group Participant Questionnaire

Your Name(Required)

First Last

Age

What is your current occupation?

What is your gender?

If you have a spouse, what is their occupation?

Have you ever worked in law enforcement?

Have you ever worked in healthcare?

Do you have children?

Have you ever been arrested or convicted of a crime?

If yes, what was the crime?

Are you registered to vote?

If yes, what are you registered as?

Do you attend church on a regular basis?

Education Level

Please list three favorite TV shows:

Please list any magazines you regularly read or websites you frequent:

Have you or an immediate family member ever been involved in a car or truck wreck and required hospitalization?

Your Address

Street Address Address Line 2 City State ZIP Code

We would love to chat with you. How can we get in touch?

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

Please let us know what's on your mind. Have a question for us? Ask away.

Your Comments/Questions(Required)

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