Reply to: job-272576578@<hidden>




Market Research company is holding interviews in Houston with people suffering from various illnesses.
Interviews last 45 minutes and incentive is $100 CASH
Dates Mid-March with times at at your convenience.


Please reply with the following information:
NAME____________________________________
AGE_____________________________________
GENDER:_________________________________
ETHNICITY_______________________________
TELEPHONE_______________________________
CONDITIONS OTHER THAN THE ONES BELOW YOU SUFFER FROM:
________________________________________
________________________________________
________________________________________
________________________________________

Please check off the conditions below which you suffer from.
If diagnosed by a physician,please put "D".
If not diagnosed but suffer from, please put "S".

DIABETES_______________________________________
EPILEPSY_______________________________________
ALLERGIES______________________________________
GERD___________________________________________
SLEEP DISORDER_________________________________
RESTLESS LEGS__________________________________
CANCER (Type?)_________________________________
DEPRESSION_____________________________________
ARTHRITIS______________________________________
FIBROMYALGIA___________________________________
ANXIETY________________________________________
SEXUAL DYSFUNCTION_____________________________
ASTHMA_________________________________________

If you take Medication for any of the above please list them beside each option.




Location: Houston