A scalp hair research study

Thank you for taking a few minutes to answer this question. Let's start now!
Q1. Your name(Fill in the blank)
    ____________
Q2. Your nationality (Fill in the blank)
    ____________
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. 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. The date you can go to the test center? (Single choice)
1.October 15th
2.October 16th
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_______
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_______
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)
    ____________

8题 | 被引用0次

模板修改
使用此模板创建