Brain Imaging Study – Newspapers

First Name

Last Name

E-mail Address

Age

Date of Birth

Gender

Ethnic Origin

Occupation

Address

Post Code

Contact Number

Are you a permanent resident in the UK and been living in the UK for the last year?

Yes, I am a permanent UK resident and have lived in the UK for the last yearNo, I am not a permanent UK residentI am a UK resident but I have not lived in the UK for at least one year

Have you taken part in a Brain Imaging Study in the past?

YesNoNot sure

Have you been contacted by another Market Research Recruiter to take part in this or any other Brain Imaging Study recently?

YesNoNot sure

Do you suffer from...

EpilepsyMigrainesNeither

How often do you suffer from migraines?

Once or twice a weekOnce a monthLess than once a monthNever

What triggers your migraines?

Do you suffer from severe sensitivity to light?

YesNo

Have you had any Brain Surgery or had any type of Brain Injury in the past?

YesNo

This study requires access to your scalp - do you wear wigs, hairpiece or any other head coverings or anything that will make access to your scalp difficult?

YesNo

Do you or any members of your household currently work, or have worked in the last year, in any of the following industries/occupations?

Advertising agency or advertising department within a companyMedia/Journalism/PublishingMarket ResearchMarketingNewspaper (either in Print or Digital)Public RelationsNone of the above

What is your Marital Status?

SingleMarriedCo-habitingWidowedDivorcedSeparated

What is your working status?

Full timePart timeStudentNonRetired

Are you happy with the information you’ve just given to me to be shared with Emerald Fieldwork and Neuro Insight? (Emerald Fieldwork are co-ordinating the whole recruitment process and Neuro Insight is the company who is carrying out the research)?

YES I AM HAPPY FOR THE INFORMATION TO BE SHAREDI AM NOT HAPPY FOR THE INFORMATION TO BE SHARED

Do you read daily newspapers in print format (paper) or digitally (on-line) nowadays?

Print (Paper)Digital (On-line)

PRINT READERS

How often do you read the following newspapers nowadays?

Every Day
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

4-6 times a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

2-3 times a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

At least once a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

Less than once a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

DIGITAL READERS

How often do you read the following newspapers nowadays?

Every Day
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

4-6 times a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

2-3 times a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

At least once a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

Less than once a week
The MirrorThe SunThe ExpressThe MailThe GuardianThe TelegraphN/A

What time of day you usually read your daily newspaper?

First thing in the morning (before work/on the way to work/with breakfast etc)Midday/LunchtimeAfternoonEarly Evening/Evening

Which group are you interested in attending?

GROUP 9: Tuesday 16th - Print - 1.00pmGROUP 11: Wednesday 17th - Print - 7.30amGROUP 16: Thursday 18th Digital - 4.30pm