JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Just Between Us - Podcast Survey
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
How often do you listen to our show?
*
Every episode
Most episodes
Occasionally
Rarely
Where do you listen to us?
*
On headphones
In the car
While doing housework
Getting ready in the morning
On my morning commute
At work
On my evening commute
While relaxing
In bed
On a home speaker
Gender identity
*
Woman
Man
Non-binary
Prefer not to say
Prefer to self-describe
Age
*
13-17
18-22
23-27
28-34
35-44
45-59
60+
Your Home
*
I rent
I'm a homeowner
I live with a guardian/caretaker
I'm buying a home soon
I own multiple homes
Prefer not to say
Other
What is your relationship status
*
Single, never married
Dating
Long-term partnered
Married
Engaged
Single, divorced or separated
Prefer not to say
Other
Do you have children in your household?
*
No
Yes
Prefer not to say
Education
*
Bachelor's degree or equivalent
Master's degree or higher
Some college
High School/GED
Prefer not to say
Your Household Income
*
Under $50,000
Between $50,000 to $100,000
Between $100,000 to $150,000
Above $150,000
Do you own any pets?
*
No
Cats
Dogs
Cats + Dogs
Other
Do you drink alcohol?
*
Yes
No
How many times a year do you go on travel?
*
1-2 times a year
2-4 times a year
4+ times a year
Do you intend to purchase any of the following in the next 12 months?
Clothing/Apparel
Home Decor
A New Makeup
A New Cleansing Product
Health/Wellbeing memberships or products
Home Improvement
Phone
Home Appliances
Car
Headphones
Laptop
Tablet
Clear selection
Submit
Clear form
This form was created inside of Melisa Diamond Monts Inc.
Report Abuse
Forms
