Community Water Quality Survey

Are you a homeowner?

What source of water do you have in your home?

Please check any conditions that you currently experience:

Last year you had your water tested? (Type "Never" if not applicable)

Do you currently use any water filtration system?

How often do you have to change filters in your home that involve water? (Brita, Fridge, Keurig, etc)

Do you buy bottled water?

To estimate water usage, how many people live in your home?

Does anyone in the family have skin irritations such as Eczema, Psoriases, etc?

Please rate your water:

Is there anything you would change about your water?

For classification purposes, please select your gender:

For classification purposes, please select your age group:

For classification purposes, please select your annual household income:

Which of the following best describes you?

What is the highest level of education that you have completed?

Are you:

How likely are you to purchase a water treatment system for your home if it did not affect your monthly budget?