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$175 Opinion Study - Health Management
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1.
Contact Info
(Required.)
Name
Phone
E-mail
Gender
Age
Primary State of Residence
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2.
What is your current or previous...
(Required.)
Occupation
Industry
3.
Which of the following best describes your annual household income?
<$50,000
$50,000-$75,000
$75,000-$100,000
$100,000-$124,999
$125,000-$149,999
$150,000-$200,000
$200,000 or more
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4.
Please specify if the household income you referenced is single income or dual income?
(Required.)
Single income (income driven by only one person)
Dual income (income driven by two people, typically a spouse or partner)
