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First name

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Date of birth

dd-mm-yyyy

Which area do you live in?

What is your full postcode?

Which of the following best describes your current relationship status?

How would you describe your current working status?

What is your average annual household income? (£GBP)

Which of the following best describes the occupation of highest income earner in your household?

Do you own or rent the home in which you live?

How many children aged 18 or over do you have?

How many children under 18 do you have?

Are you currently pregnant or trying to conceive?

If you're currently pregnant, when is your due date?

dd-mm-yyyy

First child's date of birth

dd-mm-yyyy

Second child's date of birth

dd-mm-yyyy

Third child's date of birth

dd-mm-yyyy

Fourth child's date of birth

dd-mm-yyyy

Fifth child's date of birth

dd-mm-yyyy

Sixth child's date of birth

dd-mm-yyyy

Would you be interested in hearing about research projects that your children could get involved in?

Are you a grandparent?

Which of the following areas would you say that you're interested in? Please tick all that apply.

Cars

Education

Finance

Food

Health and beauty

TV and film

Pets

Poltics

Style and beauty

Travel

Days out

How often would you like to be contacted?

Are you interested in taking part in third party research (i.e. a survey by a research company)

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