Design a questionnaire consisting of 20 questions for a pharmaceutical

company which is planning to launch a new vaccine for Flu.

Hi, we at Bizolytics, a leading market research firm globally, wanted to seek feedback from
you on the acceptance of Flu Vaccine. This will not take more than 10-15 minutes of your time.
The questions which are mentioned here do not have any right or wrong answers; we are just
interested in your honest opinion. Your opinion is highly treasured and will be kept strictly
confidential. Thank You.

Flu Vaccination Survey

Instructions: Use single code or mark only once

Demographic Profiling

1. Name (Optional): ________________________

2. Age
<25 years 1
25 to 35 years 2
35 to 50 years 3
>50 years 4

3. Gender
Male 1
Female 2

4. Education
Below Graduation 1
Graduate 2
Post Graduate 3
Others 4

5. Occupation
Professional (Engineer/ Doctor/ CA) 1
Manager 2
Supervisory level 3
Clerical/Salesmen 4
Businessman/Industrialist 5
Businessmen/ Industrialists with
6. Is your household A single income household 1
A double income Household 2

RQ1 Please choose the city where you are Code

currently living in
Mumbai 1
Delhi 2
Bangalore 3
Chennai 4
Hyderabad 5
Kolkata 6
Pune 7
1. Ahmedabad 8 Did
you get
Lucknow 9
the flu
Gurgaon 10
Other 11
RQ2. Please choose your gender. Code
Male 1
Female 2
vaccine (flu shot) last year?
Yes
No
2. I hesitate to get a flu shot because:
The flu is not a serious illness.
I’m healthy.
I don’t have time.
I don’t believe in vaccines.
I’m afraid of the side effects.
I’m afraid of needles.
I’m allergic to...
I prefer alternative medicine (homeopathic medicine) to vaccines.
I have never had the flu.
The vaccine will make me sick with the flu.
I got a flu shot last year so I don’t need it this year.
Other reason for not getting the flu vaccine: