Focus Group Participant Screening Form
Thank you for your interest in participating in a focus group for drivers in Central Oregon! If you are selected to participate, you will receive a $75 gift card as a thank you for your time. 

Vea este formulario en español aquí: https://forms.gle/yuAtTgL2FoDeKfji9
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Which locations are convenient for you to participate in an in-person focus group? *
Required
Which dates and times are you able to participate in a 1-hour focus group at the locations selected above? (select all that apply)
Monday Aug 25
Tuesday Aug 26
Wednesday Aug 27
Morning
Afternoon
Evening
Select your age: *
Select your gender: *
Select your preferred language(s) for participating in a focus group. (select all that apply) *
Required
Your responses to the following questions are confidential.
How frequently do you drive? *
Do you drive daily as part of your job? *
Which of the following best describes the area where you currently live? *
What type of vehicle do you most frequently drive? *
How often do you drive 20mph+ over the posted speed limit? *
How often do you drive after drinking more than one alcoholic beverage? *
How often do you drive after smoking marijuana? *
Which of the behaviors have you engaged in during the past month? Select all behaviors that you have done at least once. *
Required
First Name: *
Email:
Phone:
What is the best way to reach you?
Thank you!
If you are eligible to participate, our team will follow up via email or text to schedule a time to speak with you.
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