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Nick Name:
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One-line Summary (Subject):
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Recommends this product?
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Yes
No
Age:
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12 - 17
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75 - 84
85 - 94
Gender:
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Female
Male
Uses product:
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Every day
Once per week
A few times per month
A few times per year
Has owned product for:
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less than 1 day
1 day to 1 week
2 - 7 weeks
1 month
more than 1 month
Identifying Code:
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Value:
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(worst)
1
2
3
4
5
(best)
Meets Expectations:
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(worst)
1
2
3
4
5
(best)
Features:
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(worst)
1
2
3
4
5
(best)
Appearance:
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(worst)
1
2
3
4
5
(best)
Overall Rating:
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(worst)
1
2
3
4
5
(best)
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General Comment
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