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Dallas By Definition is a research firm in Las Colinas, Texas, with convenient offices in the heart of the DFW Metroplex area.  Most focus interviews will be held at our local offices.  If you are unable to travel to our location to
participate, we will still consider you for phone-based studies and online discussions.

All questions marked with an asterisk (*) are required

Contact Information

*Salutation

*First Name

*Last Name

Home Phone #

Work Phone #

Cell Phone #

 

Email Address

Demographic Information

*Date of Birth

*What is the highest level of education that you have completed?

*How would you describe your ethnic background?

*How would you describe your relationship status?

*Are you bilingual?

What is your religious affiliation?

*Are you a registered voter?

What is your party affiliation?

Work Information

*What is your employment status?

Company Name:

Job Title:

Number of Employees (Local):

Number of Employees (Worldwide):

Household Information

*Home Address

Apartment or Suite # (if applicable)

*City

*State

*Postal Code

*What is your current residence situation?

*Residence Type:

Is anyone in the household affected by the following conditions?
(Select all that apply. Scroll down to see additional selections.)

Acid Reflux Disease

Adult Incontinence

Allergies - animal related

Allergies - food related

Allergies - other

Allergies - seasonal

Arthritis

Asthma

Cancer

Carpal Tunnel Syndrome

Chronic Pain

Chronis Obstructive Pulmonary Disease (COPD)

Cystic Fibrosis

Dandruff

Depression

Diabetes

Eczema

Epilepsy

Erectile Dysfunction (ED)

Fibromyalgia

Heart Disease

Heartburn

Hemmorrhoids

High Blood Pressure(Hypertension)

High Cholesterol

HIV

Irritable Bowel Syndrome (IBS)

Joint Pain

Migraines

Multiple Sclerosis (MS)

Muscle Pain

Osteoarthritis

Osteoporosis

Polycystic Ovarian Syndrome

Psoriasis

Rheumatoid Arthritis(RA)

Sleep Apnea

Thyroid Disorder

Ulcers

Other Medical Conditions

Does anyone in the household take prescription medications?

What company provides your local telephone service?

What company provides your long distance telephone service?

Do you have a computer at home?

What company provides your internet service?

Do you use any of the following products/services?
(Select all that apply.)
 

Cable TV

Satellite TV

Satelllite Radio

HD Radio

DVR

 

Do you own any of the following recreational vehicles?
(Select all that apply.)
 

Motorcycle

ATV

Boat

Coach Camper

Fifth Wheel or Towed Camper

 

Does anyone in your household participate in the following sports/activities?
(Select all that apply. Scroll down to see additional selections.)
 

Aerobics

Baseball

Basketball

Biking

Boating

Bowling

Camping

Cheerleading

Fishing

Football

Golf

Gymnastics

Hiking

Hockey

Hunting

Racquetball

Running

Skiing

Soccer

Softball

Swimming

Tennis

Volleyball

Walking

Yoga

 

Does anyone in your household travel by air in a typical year?

Do you currently have any pets in the household?

*Into what range does your annual household income fall? (before taxes)?

*Do you have children living in the household?

Do you have a vehicle?

Products and Preferences

Who is your cell phone service provider? (if applicable)

Is your phone a Smartphone?

Do you regularly use any of the following tobacco products?

Cigarettes - Regular
Cigarettes - Menthol
Cigars
Chewing Tobacco
No Tobacco Products

Do you drink wine?

Do you drink beer?

Do you use any corrective lenses?

Have you had any kind of vision correction surgery, such as Lasik?

What kind of razor products do you use regularly?

Which kind of razor product do you use most often?

Which radio stations do you listen to regularly?
(Select all that apply. Scroll down to see additional selections.)

FM Stations

90.1 KERA

90.9 KCBI (Christian)

92.5 KZPS (Lone Star)

93.3 KLIF (i93)

94.9 KLTY

95.3 KHYI (The Range)

95.5 KJKB (Boss)

96.3 KSCS (Texas Original)

96.7 WBAP (News Talk)

97.1 KEGL (The Eagle)

97.9 KBFB (The Beat)

98.7 KLUV

99.5 KPLX (The Wolf)

100.3 KJKK (Jack FM)

101.1 WRR (Classical 101)

102.1 KDGE (The Edge)

102.9 KDMX (Mix)

103.3 KESN (ESPN)

103.7 KVIL (Lite FM)

104.1 KTDK (The Ticket)

104.5 KKDA (K104)

105.3 KRLD (The Fan)

105.7 KRNB (Smooth R&B)

106.1 KHKS (Kiss FM)

107.5 KVMK (La Nueva Mega)

Other FM Stations

AM Stations

570 AM KLIF

620 AM KMKI (Radio Disney)

820 WBAP (News Talk)

970 AM KHVN (Heaven 97)

1040 AM KGGR (Gospel Station)

1080 AM KRLD (News Radio)

1310 KTCK (The Ticket)

Other AM Stations