MARKET RESEARCH - Health Mix

We are looking for males aged 25 to 70 to take part in a discussion in Central London for 1 hour about health issues. We are looking to speak to people who have been diagnosed with Hair Loss/Balding, Hair Thinning, Premature Ejaculation or Erectile dysfunction.

VENUE:		London, W1
DATE:		Tuesday 15th July – Thursday 17th July 2014
TIME:		Various time slots available during the daytime and evening.
INCENTIVE:		£45.00

Please answer the questions below.

Name:

Telephone Number:

Postcode:

Age:

Occupation and job title of head of household:

Ethnicity:

Which of the following do you suffer from?

Asthma
Impotence
Hair Loss/Balding
Premature Ejaculation
Alopecia
Psoriasis
Erectile Dysfunction
Hair Thinning
Short Sightedness

Are you currently taking medication for any of these conditions? Yes/No?

If you are currently taking medication for any of these conditions, Please specify the names of any medication you are taking.

If you are not currently taking medication, are you seeking medication for any of these conditions? Yes/No

Please forward this on to anyone you know who may be interested.

Unfortunately, it is impossible to reply to all emails or phone messages. We receive lots of responses to researches that are emailed out. You will be contacted by phone if your application is successful. However, we apologise if you do not hear from us, but please keep trying for future projects that are sent out.

We look forward to hearing from you.

Kind regards,

Daliah Salem
trend MARKET RESEARCH