Political Opinion Poll Survey
Full Name
Email Address
Age Group
18-24
25-34
35-44
45-54
55-64
65+
Location (City/State)
Political Affiliation
Party A
Party B
Party C
Independent
Other
How satisfied are you with the current government?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Which issues are most important to you? (Select all that apply)
Economy
Healthcare
Education
Environment
Safety
Other
Any additional comments or opinions?