Group 4/Section 4 Oxygen Tanks Refilling & Rental Services

FAR EASTERN UNIVERSITY- MANILA

Institute of Accounts, Business, and Finance
Department of Accountancy and Internal Auditing

CONSENT

Voluntary Participation
Your participation in this study is completely voluntary. Should you elect to discontinue participation; any
information already collected will be discarded. There is no penalty or loss of benefit for choosing not to
participate.

Right to Withdraw from the Study

You have the right to withdraw from the study at any time without consequence or penalty.

Agreement
If you wish to participate in this study, please sign the form below. A signature will indicate agreement to
participate.

Participant’s Name:(Print)___________________ Signature:____________ Date:__________

SURVEY QUESTIONNAIRE
(DEMAND)
Dear Sir/Madam,

We, Third Year Accountancy students of this university, are currently conducting a feasibility study on
“Oxygen Tanks Refilling and Rental Services” in compliance with the partial requirement of the course
Strategic Business Analysis. In this regard, we would like to seek your assistance to accomplish this
questionnaire.

In compliance with Republic Act. 10173, otherwise known as Data Privacy Act of 2012, the proponents
shall ensure reasonable steps to protect any personal data you provide and to protect such information
from misuse, unauthorized access, disclosure, and other prejudicial action against you.

Rest assured that the data you will provide will be treated with utmost confidentiality and will be used for
academic purpose only. Thank you for your cooperation.

Business Proponents

I. PROFILE OF THE RESPONDENTS

Direction: Please put a check mark (√) on the space provided that corresponds to your
answer.

Gender: [ ] Male [ ] Female

Age: [ ] 25-29 years old [ ] 35-39 years old

[ ] 30-34 years old [ ] 40-44 years old
[ ] 45-49 years old [ ] 50-54 years old
[ ] 55-59 years old

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Group 4/Section 4 Oxygen Tanks Refilling & Rental Services

Residence (Bulacan)
☐ Angat ☐ Guiguinto ☐ Paombong
☐ Balagtas ☐ Hagonoy ☐ Plaridel
☐ Baliuag ☐ City of Malolos ☐ Pulilan
☐ Bocaue ☐ Marilao ☐ San Ildefonso
☐ Bulacan, Bulacan ☐ Meycauayan ☐ San Jose Del Monte
☐ Bustos ☐ Norzagaray ☐ San Miguel
☐ Calumpit ☐ Obando ☐ San Rafael
☐ Doña Remedios ☐ Pandi ☐ Sta. Maria
Trinidad
☐ Others, please specify: _________

Net Monthly Family Income: [ ] Below ₱5,000

[ ] ₱5,000 - ₱15,000
[ ] ₱15,001 - ₱25,000
[ ] ₱25,001 - ₱35,000
[ ] ₱35,001 - ₱45,000
[ ] ₱45,001 - ₱55,000
[ ] ₱55,001 - ₱65,000
[ ] ₱65,001 and above

Source of Income: [ ] Allowances

[ ] Salaries and Wages
[ ] Remittances
[ ] Business Income
[ ] Passive Income (dividends, interests)
[ ] Commission
[ ] Others, please specify: ______

Income Classification: [ ] Poor (below ₱10,957)

[ ] Low Income but not poor Income ( ₱10,957 - ₱21,914)
[ ] Lower-Middle Income (₱21,914 - ₱43,828)
[ ] Middle Income (₱43,828 - ₱76,669)
[ ] Upper-Middle Income (₱76,669 - ₱131,484)
[ ] Upper-Middle but not rich Income (₱131,483 - ₱219,140)
[ ] Rich Income (Above ₱219,140)

Working Status:
☐ Full-time Student
☐ Working Student
☐ Employed
☐ Self Employed (With Business)

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Group 4/Section 4 Oxygen Tanks Refilling & Rental Services

☐ Others, please specify: _____________________

Source: (Philippine Institute for Development Studies,2021)

-----------------------------------------------------------------------------------------------
II. SURVEY QUESTIONNAIRES
Direction: Please put a check mark (√) on the space provided that corresponds to
your answer.

1. Have you or any of your family member have been recently or in the past
diagnosed with any respiratory disease/s?
[ ] Yes [ ] No
If no, proceed to number 4.

2. If yes, what disease?

[ ] Chronic Obstructive Pulmonary Disease
[ ] Pneumonia
[ ] Pulmonary Fibrosis
[ ] Asthma
[ ] COVID-19
[ ] Others (Please Specify): ______________________

3. What medication did your doctor prescribe to be used to ease the

breathing discomfort?
[ ] Inhaler [ ] Oral or nasal allergy medicine
[ ] Oxygen tank [ ] Others, please specify________

4. How many of these medications do you usually buy?

Quantity Inhaler Oral or Nasal Oxygen Tank Others

Allergy
Medications Medicine
0-1
2-3
4-5
6 and above

5. How often do you buy these medications?

Frequency Inhaler Oral or Nasal Oxygen Tank Others

Allergy
Medications Medicine
0-1 per quarter
2-3 per quarter
4-5 per quarter
6 and above

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Group 4/Section 4 Oxygen Tanks Refilling & Rental Services

per quarter

6. How much do you usually spend for this medication?

Price Inhaler Oral or Nasal Oxygen Tank Others

Allergy
Medications Medicine
Below ₱500
₱ 500-999
₱ 1,000-1,999
₱ 2,000-2,999
₱3,000 and
above

7. How many of your family members need this type of medication for their
respiratory condition?
[ ] 0 -1 [ ]4-5
[ ] 2 -3 [ ] Others (Please Specify): ______

8. Are you willing to buy an oxygen tank at home if ever needed for any health
condition?
[ ] Yes [ ] No
If No, disregard this questionnaire.

9. If Yes, please select the type of oxygen equipment that you would like to
use for your condition.
[ ] Stationary Concentrator [ ] Liquid Oxygen
[ ] Standard Gas Cylinders [ ] Portable Oxygen Concentrator

10. Which size of oxygen tanks do you prefer to purchase?

[ ] 5 pounds [ ] 25 pounds
[ ] 10 pounds [ ] 50 pounds
[ ] 20 pounds

11. If yes, how much are you willing to pay for oxygen tank?

Size of Less than P5,000 – P11,000- Above

Oxygen Tank P5,000 P10,000 P25,000 P25,000

5 pounds
10 pounds
20 pounds
25 pounds
50 pounds

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Group 4/Section 4 Oxygen Tanks Refilling & Rental Services

12. How often will you buy Oxygen Tanks?

Size Weekly Monthly Quarterly Semi- Annually

Period Annually
5 pounds
10 pounds
20 pounds
25 pounds
50 pounds

13. How many oxygen tank will you buy?

Size 0-1 2-3 4-5 6 and above

Quantity
5 pounds
10 pounds
20 pounds
25 pounds
50 pounds

14. Where do you prefer to buy/avail of the supplemental oxygen for your
medications?
[ ] Hospital [ ] Home
[ ] Pharmacy [ ] Oxygen Tank Stores

15. How fast would you want it to be delivered?

[ ] Less than 30 minutes
[ ] 30 minutes
[ ] 60 minutes/one hour

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Group 4/Section 4 Oxygen Tanks Refilling & Rental Services