Retail Environment Intolerance Assessment
Help us understand your sensitivities and experiences in retail settings to improve comfort and accessibility.
Full Name
*
First Name
Last Name
Age Group
*
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
How often do you visit retail environments (e.g., stores, malls, supermarkets)?
*
Daily
Weekly
Monthly
Rarely
Never
Which types of retail environments do you visit most frequently? (Select all that apply)
*
Supermarkets/Grocery Stores
Shopping Malls
Department Stores
Convenience Stores
Boutiques/Small Shops
Other
Please rate your level of discomfort with the following factors in retail environments:
*
Rows
No Discomfort
Mild Discomfort
Moderate Discomfort
Severe Discomfort
Intolerable
Bright lighting
1
2
3
4
5
Loud noises/music
6
7
8
9
10
Crowded spaces
11
12
13
14
15
Strong scents/fragrances
16
17
18
19
20
Temperature (too hot/cold)
21
22
23
24
25
Visual clutter
26
27
28
29
30
Have you ever left a retail environment early due to discomfort?
*
Yes
No
If yes, what were the main triggers for your discomfort? (Select all that apply)
Lighting
Noise
Crowds
Scents
Temperature
Other
Which physical or emotional symptoms do you experience in uncomfortable retail environments? (Select all that apply)
*
Headache
Fatigue
Anxiety
Dizziness
Irritability
Other
How do these experiences impact your shopping habits?
*
I avoid certain stores/environments
I shop less frequently
I shop online instead
No significant impact
Other
What strategies or tools do you use to manage discomfort in retail environments? (Select all that apply)
Earplugs/Headphones
Sunglasses/Hats
Mask/Scarf (for scents)
Taking breaks
Shopping at less busy times
Other
Please provide any additional comments or suggestions for improving comfort in retail environments.
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