Please tell us about Yourself, and Your Water Habits

Questionnaire

This survey is divided into the following sections, the links directly below can take you to any part of the survey immediately. We dearly appreciate any and all responses, so please, information you give us helps make this a better site.

About Yourself
about your Typical Fluid Intake
Optional Section
Form Submission

Please note! At this time our ISP has changed and we are working on getting the form submission redirected. Therefore you will not be able to send in this questionnaire. Please check back. Thank you!

SECTION A -- about Yourself

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

First Name

Last Name

E-mail Address

What is your sex? Male Female

What is your age?
Under 21 21-40 41-49 50-59 60-69
70-79 80-89 90 Plus

Would you like to receive our MONTHLY emailing
concerning water, health, breathing, attitudes, and much, much more?
(select to receive mailing)

How did you locate our web site?
Our advertisement if so, where?

Web Link if so, name of site link is located

Search engine if so, search engine

keywords used

Other if so, please specify

SECTION B -- about your Typical Fluid Intake

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

Are you a water drinker? Yes No
if so, how much water daily?

Do you drink more water this year than, (select both if both are true)
1 year ago
5 years ago

Do you drink bottled water? Yes No
if so, what brand name?

Do you received artisan or bottled water service? Yes No
if so, where? Home Office

Do you use a water filtration system? Yes No
if so, what brand?
and are you happy with its performance? Yes No

Do you carry water in your car? Yes No

Do you keep water with you where ever you go? Yes No
if so, what kind of container do you carry it in?
and do you consider it adequate? Yes No

Do you drink coffee? Yes No
if so, cafeinated or Decaffeinated

Do you drink soda? Yes No
if so, what brand name?

Do you donate blood? Yes No
if so, how much
and to what program

SECTION C -- Optional Questions

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

Do you belong to a diet program? Yes No
if so, name of program
are you happy with the results?
if you could make the program better, how would you?

Section D: Form Submission

After hitting the send button the results of the form will be
sent to GotWater.net!

Your browser will be redirected to Got Water's home page.

Questionnaire

This survey is divided into the following sections, the links directly below can take you to any part of the survey immediately. We dearly appreciate any and all responses, so please, information you give us helps make this a better site.

About Yourself

about your Typical Fluid Intake

Optional Section

Form Submission

SECTION A -- about Yourself

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

First Name

Last Name

E-mail Address

What is your sex? Male Female

What is your age?
Under 21 21-40 41-49 50-59 60-69
70-79 80-89 90 Plus

Would you like to receive our MONTHLY emailing
concerning water, health, breathing, attitudes, and much, much more?
(select to receive mailing)

How did you locate our web site?
Our advertisement if so, where?

Web Link if so, name of site link is located

Search engine if so, search engine

keywords used

Other if so, please specify

SECTION B -- about your Typical Fluid Intake

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

Are you a water drinker? Yes No
if so, how much water daily?

Do you drink more water this year than, (select both if both are true)
1 year ago
5 years ago

Do you drink bottled water? Yes No
if so, what brand name?

Do you received artisan or bottled water service? Yes No
if so, where? Home Office

Do you use a water filtration system? Yes No
if so, what brand?
and are you happy with its performance? Yes No

Do you carry water in your car? Yes No

Do you keep water with you where ever you go? Yes No
if so, what kind of container do you carry it in?
and do you consider it adequate? Yes No

Do you drink coffee? Yes No
if so, cafeinated or Decaffeinated

Do you drink soda? Yes No
if so, what brand name?

Do you donate blood? Yes No
if so, how much
and to what program

SECTION C -- Optional Questions

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

Do you belong to a diet program? Yes No
if so, name of program
are you happy with the results?
if you could make the program better, how would you?

Section D: Form Submission

After hitting the send button the results of the form will be
sent to GotWater.net!

Your browser will be redirected to Got Water's home page.

Questionnaire

This survey is divided into the following sections, the links directly below can take you to any part of the survey immediately. We dearly appreciate any and all responses, so please, information you give us helps make this a better site.

About Yourself

about your Typical Fluid Intake

Optional Section

Form Submission

SECTION A -- about Yourself

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

First Name

Last Name

E-mail Address

What is your sex? Male Female

What is your age? Under 21 21-40 41-49 50-59 60-69 70-79 80-89 90 Plus

Would you like to receive our MONTHLY emailing concerning water, health, breathing, attitudes, and much, much more? (select to receive mailing)

How did you locate our web site? Our advertisement if so, where?

Web Link if so, name of site link is located

Search engine if so, search engine

keywords used

Other if so, please specify

SECTION B -- about your Typical Fluid Intake

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

Are you a water drinker? Yes No if so, how much water daily?

Do you drink more water this year than, (select both if both are true) 1 year ago 5 years ago

Do you drink bottled water? Yes No if so, what brand name?

Do you received artisan or bottled water service? Yes No if so, where? Home Office

Do you use a water filtration system? Yes No if so, what brand? and are you happy with its performance? Yes No

Do you carry water in your car? Yes No

Do you keep water with you where ever you go? Yes No if so, what kind of container do you carry it in? and do you consider it adequate? Yes No

Do you drink coffee? Yes No if so, cafeinated or Decaffeinated

Do you drink soda? Yes No if so, what brand name?

Do you donate blood? Yes No if so, how much and to what program

SECTION C -- Optional Questions

All questions are optional, please fill out as much or little as you like. Remember, the more questions you answer, the better we can make this site for you and other viewers in the future.

Do you belong to a diet program? Yes No if so, name of program are you happy with the results? if you could make the program better, how would you?

Section D: Form Submission

After hitting the send button the results of the form will be sent to GotWater.net! Your browser will be redirected to Got Water's home page.

What is your age?
Under 21 21-40 41-49 50-59 60-69
70-79 80-89 90 Plus

Would you like to receive our MONTHLY emailing
concerning water, health, breathing, attitudes, and much, much more?
(select to receive mailing)

How did you locate our web site?
Our advertisement if so, where?

Are you a water drinker? Yes No
if so, how much water daily?

Do you drink more water this year than, (select both if both are true)
1 year ago
5 years ago

Do you drink bottled water? Yes No
if so, what brand name?

Do you received artisan or bottled water service? Yes No
if so, where? Home Office

Do you use a water filtration system? Yes No
if so, what brand?
and are you happy with its performance? Yes No

Do you keep water with you where ever you go? Yes No
if so, what kind of container do you carry it in?
and do you consider it adequate? Yes No

Do you drink coffee? Yes No
if so, cafeinated or Decaffeinated

Do you drink soda? Yes No
if so, what brand name?

Do you donate blood? Yes No
if so, how much
and to what program

Do you belong to a diet program? Yes No
if so, name of program
are you happy with the results?
if you could make the program better, how would you?

After hitting the send button the results of the form will be
sent to GotWater.net!

Your browser will be redirected to Got Water's home page.