Asthma Research
Thank-You for taking the time to complete this form; it will help me develop a product to be used by children.
Please answer as many questions you feel comfortable to do so.
Please let other people know about this to get a larger understanding of the needs of parents/carers.
I will be tabulating the response and be giving updates to the project here on a weekly basis.
Thank-you for your time.
I propose posting my project on the web for you all to follow; please visit
www.projectresearch.co.uk
(website ordered today....up and running soon. This is a website for my use and not a commercial one)
Name of form filler (optional)
Prefix
First
Last
Suffix
Email (optional)
Confirm
sex of form filler (optional)
Male
Female
Rather not say.
age of form filler (optional)
*
Under 18
18-24
25-34
35-44
45-54
55-64
65 or Above
Prefer Not to Answer
name of product user (optional)
Prefix
First
Last
Suffix
sex of product user (optional)
Male
Female
Rather not say.
age of product user (optional)
Under 18
18-24
25-34
35-44
45-54
55-64
65 or Above
Prefer Not to Answer
product size
small shoe box: kids
medium shoe box: ladies
large shoe box: mens
x-large shoe box: boots
other (fill in comments box at end)
features
inhaler holder
cream holder
drink holder
tissue holder
night light (comes on when dark)
manual light (user switches on)
ALARM (sounds in room)
ALARM (sounds on remote unit)
glow in dark
drawer
music
other (fill in comments box at end)
If ALARM answered
wired
wireless
don't mind
bed type
normal
cabin
bunk
other (fill in comments box at end)
colour
blue
pink
red
orange
yellow
green
clear
black
white
funky kids
rainbow
other (fill in comments box at end)
cost
up to £10
£10 to £15
£15 to £20
£20 to £30
£30 +
cheap as possible
doesn't matter if product does job
other (fill in comments box at end)
power
mains
battery
both
portable
yes
no
don't mind
comments
Powered by
EMF
Web Form
Report Abuse