A scalp hair research study - 问卷调查调研模板

A scalp hair research study

Thank you for taking a few minutes to answer this question. Let's start now!

Q1:Q1. Your name（Fill in the blank）

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Q2:Q2. Your nationality （Fill in the blank）

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Q3:Q3. Your age （Single choice）

1. under 20 years old

2. Aged 20-30

3. 31-40 years old

4. 41-50 years old

5. 51-60 years old

6. above 60 years old

Q4:Q4. When did you last perm/dye your hair? （Single choice）

1.Within one month

2.Within one month to one and a half months

3.Within one and a half months to two months

4.Within two months to two and a half months

5.Three months and above

6. Never

Q5:Q5. The date you can go to the test center? （Single choice）

1.October 15th

2.October 16th

Q6:Q6-1. What is the time period you can go to the test center on October 15th (the test center can receive up to 2 visitors in one time period)? （Single choice）

1.From 9:30 a.m. to 12:30 p.m.

2.From 13:15 p.m. to 16:15 p.m.

3.From 14:45 p.m.to 17:45 p.m.

4.other_______

Q7:Q6-2. What is the time period you can go to the test center on October 16th (the test center can receive up to 2 visitors in one time period)? （Single choice）

1.From 10:00 a.m. to 13:00 p.m.

2.From 13:30 p.m. to 16:30 p.m.

3.Other_______

Q8:Q7. If you are willing to participate in the test, please leave your contact information (WeChat or email). We will contact you after the Chinese National Day.（Fill in the blank）

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