Survey

COBBTF Bed Bugs Survey

* 1. What city do you live in?



2. If "none of these", please fill in your city.

* 3. What county do you live in?

4. If "none of these", please fill in your county.

* 5. What is your zip code?

* 6. What type of residence do you live in?

* 7. Do you have bed bugs now? If "no," skip to question 16.

* 8. If yes, what are you doing to get rid of them?

9. If you are trying to do it yourself, which of the following have you done? (check all that apply)

10. If "something else", please explain.

11. If you threw out furniture or a mattress, did you:

12. If you rent, has the landlord taken steps to exterminate the bugs?

13. If "yes", what did he/she do?

14. If "no", did you file a complaint with a government agency?

15. If "yes", which government agency?

* 16. Have you ever had bed bugs? If "no", skip to question 21.

17. If you HAD bed bugs and got rid of them, how did you do it?

18. If you took care of it yourself, which of the following did you do? (check all that apply)

19. If "something else", please explain.

20. If you threw out furniture or a mattress, did you:

* 21. My age is:

* 22. My house hold income is:

Page 1 out of 1

All answers remain confidential and anonymous; data analysis will not identify individuals.

Print Friendly