Be paid for your opinions!

We are pleased to include you in our database of research panelists. We conduct discussion groups and interviews for clients who want information on various topics, (e.g. customer and product satisfaction, quality control, advertising and product development ideas). Our clients are looking for people who fit a profile or group of profiles and they appreciate the value of your time, so they pay "incentives" usually from $50 to $200 or more, depending on the topic and duration.

The questionnaire takes about 5-10 minutes; it is divided into basic demographic information and information about your lifestyle and preferences.

We often post information about studies on our Facebook Page. Be sure to like us on Facebook to keep up to date on upcoming studies.

None of the information included here will be used for sales purposes or given to other companies.
What type of research are you interested in participating in?

Question Title

* 1. What type of research are you interested in participating in?

In what location(s) would you be willing to participate in a focus group or interview? (please check all that apply)

Question Title

* 2. In what location(s) would you be willing to participate in a focus group or interview? (please check all that apply)

Name

Question Title

* 3. Name

Gender

Question Title

* 4. Gender

Ethnicity

Question Title

* 5. Ethnicity

Do you speak a language in addition to English?

Question Title

* 6. Do you speak a language in addition to English?

Birthdate

Question Title

* 7. Birthdate

Birthdate
Email address-Please provide us with the email address to which you would correspondence about research studies. Your email will be used for that purpose only and will not be shared.

Question Title

* 8. Email address-Please provide us with the email address to which you would correspondence about research studies. Your email will be used for that purpose only and will not be shared.

Address

Question Title

* 9. Address

Telephone Number

Question Title

* 10. Telephone Number

Maritial Status

Question Title

* 11. Maritial Status

Do you own or rent your primary residence?

Question Title

* 12. Do you own or rent your primary residence?

Please provide us with information about your voter registration

Question Title

* 13. Please provide us with information about your voter registration

Birthdates of your child(ren)

Question Title

* 15. Birthdates of your child(ren)

Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Current employment status

Question Title

* 16. Current employment status

Current job title

Question Title

* 17. Current job title

Current employer

Question Title

* 18. Current employer

Company size of current employer (all locations)

Question Title

* 19. Company size of current employer (all locations)

Occupation (If you are not employed or are retired, but have previously worked, please indicate your former occupation.

Question Title

* 20. Occupation (If you are not employed or are retired, but have previously worked, please indicate your former occupation.

What is your highest level of education?

Question Title

* 21. What is your highest level of education?

Which of these categories best describes the combined annual income of all members of your household (before taxes)?

Question Title

* 22. Which of these categories best describes the combined annual income of all members of your household (before taxes)?

Do you have health insurance? (please check as many or as few apply to you)

Question Title

* 24. Do you have health insurance? (please check as many or as few apply to you)

On average, how many prescriptions are you responsible for filling each month for your household? (include refills)

Question Title

* 25. On average, how many prescriptions are you responsible for filling each month for your household? (include refills)

Where do you fill or refill prescriptions? (Please check all that apply)

Question Title

* 26. Where do you fill or refill prescriptions? (Please check all that apply)

Which type of cellular phone do you use?

Question Title

* 27. Which type of cellular phone do you use?

Were you referred to us by someone you know? (If so, please specify first/last name as we offer referral incentives often)

Question Title

* 28. Were you referred to us by someone you know? (If so, please specify first/last name as we offer referral incentives often)

If you were not referred by someone you know,how did you hear about us? (please check as many or as few as apply to you)

Question Title

* 29. If you were not referred by someone you know,how did you hear about us? (please check as many or as few as apply to you)

Please let us know about any sports, hobbies or interests that you pursue. Is there anything else you would like us to know about you?

Question Title

* 30. Please let us know about any sports, hobbies or interests that you pursue. Is there anything else you would like us to know about you?

Please provide us with names and email of people who may be interested in participating in research.

Question Title

* 31. Please provide us with names and email of people who may be interested in participating in research.

Thank you for your time and interest. We look forward to contacting you with a suitable project.

T