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August - September
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Age
*
Your answer
Phone Number
*
Your answer
Gender
*
Male
Female
Non-Binary
Prefer not to say
Ethnicity
*
African American
Asian/Pacific Islander
Caucasian
Hispanic
Middle Eastern
Native American
Something Else
What CITY do you live in
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Your answer
What COUNTY do you live in
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Your answer
What STATE do you live in (ex- CA, NY, TX etc.)
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Your answer
What region do you live in?
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Midwest
Northeast
South
West
What are do you live in?
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Urban
Suburban
Rural
Highest Level of Education
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Less than High School
High School/GED
Some College/Trade
Associates Degree/2 year
Bachelors Degree/4 year
Some Post Grad education
Post Grad/ Masters Degree
Employment Status
*
Full time
Part time
Self Employed
Full Time Student (Unemployed)
Homemaker
Retired
Unemployed
What is your current occupation? (please list previous if unemployed, homemaker or retired)
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Your answer
What industry do you work in? (please list previous if unemployed, homemaker or retired)
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Your answer
Annual *Household* income (Everyone working adult in your home combined)
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Less than $20,000
$20,000 -$29,999
$30,000 -$39,999
$40,000-$59,999
$60,000-$79,999
$80,000-$99,999
$100,000 or More
Marital Status
Single (Never married)
Single (Living with partner)
Married
Seperated
DIvorced
Widowed
Clear selection
Do you own or rent you home?
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Own
Rent
Some other living arrangement
What type of home do you live in?
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Apartment
Condo
Mobile Home
Single Family home
Townhome
Something Else
If you have children, how old are they?
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0-12 months
1-2
3-4
5-6
7-8
9-10
11-12
13-14
15-17
18+
I do not have children
Required
Do you fall into any of the following categories?
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On a medically prescribed diet
On a gluten-free diet
A vegetarian
Purchase only food that has not been genetically modified (non-GMO)
Keep Kosher
Purchase only organic food
Have food allergies
Have a food or eating disorder
None of these
Required
Do you consume alcoholic beverages?
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Yes
No
Please tell me to what degree you participate in the decision of selecting a casual dining restaurant to dine at?
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Almost always am the primary decision maker
Share equally in the responsibility in making the decision
Sometimes make the decision
Rarely or never make the decision
Please indicate how often you consume BEER when you visit casual dining restaurants for dinner or happy hour where they are available
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Every/Almost Every Time
Most of the Time
Sometimes
Every once in a while
Never
Please indicate how often you consume Bloody Mary's when you visit casual dining restaurants for dinner or happy hour where they are available
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Every/Almost Every Time
Most of the Time
Sometimes
Every once in a while
Never
Please indicate how often you consume Margaritas when you visit casual dining restaurants for dinner or happy hour where they are available
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Every/Almost Every Time
Most of the Time
Sometimes
Every once in a while
Never
Please indicate how often you consume Wine when you visit casual dining restaurants for dinner or happy hour where they are available
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Every/Almost Every Time
Most of the Time
Sometimes
Every once in a while
Never
Please tell me which of the following casual dining restaurants, if any, have you visited in the past **12 months** for dining in or carry out.
*
Applebee’s
Outback Steakhouse
Chuy’s
Mi Cocina
Cheddar’s
Chili’s
TGIFriday’s
On the Border
Buffalo Wild Wings
Texas Roadhouse
Longhorn Steakhouse
BJ’s
None of these
Required
Please tell me which of the following casual dining restaurants, if any, have you visited in the past **6 months** for dining in or carry out
*
Applebee’s
Outback Steakhouse
Chuy’s
Mi Cocina
Cheddar’s
Chili’s
TGIFriday’s
On the Border
Buffalo Wild Wings
Texas Roadhouse
Longhorn Steakhouse
BJ’s
None of these
Required
Please tell me which of the following casual dining restaurants, if any, you would NEVER visit.
*
Applebee’s
Outback Steakhouse
Chuy’s
Mi Cocina
Cheddar’s
Chili’s
TGIFriday’s
On the Border
Buffalo Wild Wings
Texas Roadhouse
Longhorn Steakhouse
BJ’s
I would visit all of these
Required
Which sit-down restaurant(s) do you visit frequently? Please list your favorite go-to's. Please be detailed.
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Your answer
What do you usually order to drink at this/these restaurant(s)? Why? Please be detailed
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Your answer
If money was not an issue and you had 3 months of free time to do anything you want, what would you do and why? Please be detailed.
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Your answer
What has been your favorite restaurant menu item (at any restaurant)? Please tell us why it is your favorite above all others. Please be detailed.
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Your answer
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