Please fill out our short survey and get a free Garelick Farms product!

The “Fight Osteoporosis Now” campaign is interested in your feedback.  After you have browsed www.fightosteonow.org, please take about 3 minutes to answer these questions.  We’ll send you a coupon for a free Garelick Farms product, worth up to $3.99.

1. How did you learn about this website? (check all that apply)

 Metro Newspaper
 MBTA station
 MBTA train
 Health care provider
 Fitness facility
 School/university
 Television
 Radio

2. What do you think is the main message of the website?

Please rank your response to the following statements:

3. All women are at risk for osteoporosis.

Strongly Agree Agree  Disagree  Strongly Disagree

4. Young people can take steps to help prevent osteoporosis.

Strongly Agree Agree  Disagree  Strongly Disagree

Please answer the following questions:

5. The information in this website helped me to better understand what osteoporosis is Yes No Don’t know
6. This website provides information that helps people to get more calcium. Yes No Don’t know
7. This website provides information that helps people to get more physical activity. Yes No Don’t know

8. After reading the website, please rate the likeliness that you will do the following:

Order a brochure online Highly Likely Likely Unlikely Highly Unlikely
Tell a friend Highly Likely Likely Unlikely Highly Unlikely
Get more calcium Highly Likely Likely Unlikely Highly Unlikely
Get more physical activity Highly Likely Likely Unlikely Highly Unlikely

How old are you? years old
     
What is your zip code?  

What is your race/ethnicity?

Asian
Alaska Native/American Indian
Native Hawaiian or other Pacific Islander
Black or African-American
Cape Verdean
Haitian
Brazilian
Puerto Rican
Dominican
Hispanic/Latino
White
Other      

If you’d like a coupon for a free Garelick Farms product (up to $3.99 value), please fill in your name and address below:

Your Name
Address
Address 2
City
State MA
E-mail

Thank you very much for taking the time to complete our short survey.
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