Sample Survey Page

View the source code to see how these questions are implemented and the script is called 

1. Enter the number of equine you currently own: 

2. Enter your zip code: 

3. Select from the following list the category which best describes your primary involvement in the horse industry.

as a veterinarian
as a horse owner
as a horse care provider such as farm or stable owner or employee
as a horse trainer or judge
if none of these categories fit you
skip
4a. Select from the following list the primary use of the horse(s) you own or are involved with.
for racing for which there is parimutuel betting
for showing or competition other than racing
for breeding
for farm or ranch use
for pleasure use or as a companion
for another primary use
skip
4b. Select from the following list the primary breed of horse you own or are involved with.
Quarter Horse
Thoroughbred or Standardbred
Colored Breed such as Paint or Appaloosa
Arabian
any other breed or cross-bred horse
skip
5a. Rank each of the following general issues as high, medium or low priority for a National (USA) equine health study.

Mike Moxcey Oct 1997