$100 PHONE INTERVIEW - SENIORS 65 AND UP
It's always a pleasure communicating with our Seniors.

Elite Market Research has a study for Seniors that are 65 and up. THERE ARE NO SALES... We are looking for men and women that currently have MEDICARE & MEDICAID BUT WITH 2 DIFFERENT INSURANCE COMPANIES..

We only want your opinions regarding the ease of use and convenience of having these 2 awesome services and what can be done to make them better. All participants will receive $100 for their time.
Fill out the questionnaire and submit it. We will call you for scheduling.

If you have any questions or concerns please call me at 567-277-8657. Thank you.

Marshia Hamilton, Owner
567-277-8657

Email address *
In what city and state do you live? *
BOTH CITY AND STATE ARE REQUIRED
Your answer
ZIP CODE *
Your answer
PHONE NUMBER *
Your answer
FIRST & LAST NAME *
BOTH NAMES ARE REQUIRED
Your answer
1. WHAT IS YOUR AGE? *
Your answer
2. GENDER *
3. Please select the option that best matches your total household income. *
5. What is the nearest MAJOR city that you live in or near? *
Your answer
6. Please select the statement that best describes your eligibility for Medicare &/or Medicaid. *
7. Please choose the statement that best describes your source of health insurance. *
8. <if a dual eligible> Is your Medicare and Medicaid plan administered from the same insurance company? *
9. <if a dual eligible> Please select the Health Insurance company that administers your dual Medicare and Medicaid plan. *
ONLY ONE ANSWER IS ACCEPTABLE
Required
10. Are you available for a 1-Hour Phone Call before Tuesday, November 13th? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service