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Jan. 30th Focus Group
What is your first name?
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What is your last name?
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What is your age?
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What is your phone number? This is needed to contact you about the focus group.
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What is your email address?
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What is your street address?
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What city do you live in?
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What state do you live in?
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What is your zip code?
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What county do you reside in?
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What is your highest level of education?
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GED/High School
Associate Degree
Bachelor Degree
Master Degree
Doctorate
I did not complete high school
What best fits your working situation?
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I am retired
I am currently working
I am unemployed
What is your occupation? If unemployed, write N/A. If retired, please state what your occupation was while working.
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Have you or someone in your immediate family ever been part of a lawsuit?
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Yes
No
If yes, please explain. If no, write N/A.
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Are you or a family member employed by a law firm, in healthcare, or working for an insurance company?
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Yes
No
If you answered yes to the above mentioned question, please explain who is employed by a law firm, in healthcare, or working for an insurance company. If you answered no, write N/A.
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Have you or anyone close to you ever been severely injured in an accident?
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Yes
No
If you answered yes, please explain. If you answered no, write N/A.
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How do you feel about people who are injured that want to sue?
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A
It is their right to sue
B
It is ridiculous
C
It just depends on the situation
You have applied to be part of a Zoom Focus Group. This will be video recorded so the attorney can prepare for a case well. Do you consent to be video recorded?
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Yes, I consent to being recorded.
No, I do not consent to be recorded.
If chosen for this Focus Group, you will be hearing facts about a real case. Do you agree to keep everything you hear confidential? This information should not be shared with anyone outside of the Focus Group.
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Yes, I agree to maintain confidentiality. I will not talk to anyone about the case.
No, I do not agree to maintain confidentiality, and realize that this forfeits my chance of being on this focus group.
In order to be paid for being part of the Focus Group, you must stay for the entire session. Are you able to meet this requirement?
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Yes, I am able to stay for the whole Focus Group.
I am not sure I will be able to stay for the whole thing, and realize I will not be paid at all if I don't stay.
The law firm will mail a $150.00 check via the U.S. Postal Service within a week of completing the Focus Group. You understand that receiving payment may take up to two weeks.
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Yes, I understand that payment will come directly from the law firm, may take up to two weeks and that this is the only method of payment; a check.
No, I am not willing to wait for payment, and realize this forfeits my chance of being part of this focus group.
This Focus Group will be held via Zoom. Do you know how to use Zoom?
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Yes, I know how to use Zoom.
No, but I have someone who will show me.
I don't know what Zoom is.
Because this is a confidential matter, we ask that you utilize a private, uninterrupted area and use your own computer. Can you meet the requirements?
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Yes, I have a quiet uninterrupted area, and I own my computer.
No, I can't guarantee this.
Would you like to be considered for future focus groups?
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Yes
No
Submit