If you require something more specific or more robust, I can create a customized proposal for you. Please email me directly at firstname.lastname@example.org to arrange for a consultation. Please note that prices for a custom survey start at $25,000.
Also, if your study requires qualitative research (focus groups, live interviews) or secondary research (Nielsen data, desk research, internal database analysis) I can help you with that as well. Prices vary widely depending on your requirements.