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Up to $595 Technology Study
*
1.
General Information
(Required.)
Full Name:
Email:
Phone:
Age:
Gender:
City, State:
Zip Code:
2.
What is your date of birth?
DOB
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
*
3.
Which location are you interested in?
(Required.)
Los Angeles (LA) - Within 50 miles
Philadelphia (PHL) - Within 50 Miles
San Francisco (SF) - Within 50 Miles
Other (please specify)
*
4.
Do you have any severe food allergies that would prevent you from safely participating in a study that involves tasting, handling, or being in the presence of various food items? Please note that while the study team will disinfect the facilities after each participant's session, it cannot be guaranteed that trace amounts of food will not be left over from a previous session. Some examples of foods are almonds, chips, and yogurt.
(Required.)
Yes, I have a severe food allergy
I have a food allergy, but it is not severe
No
*
5.
Do you have any dietary restrictions?
(Required.)
No restrictions
Vegan
Vegetarian
Gluten-free
Paleo
Other (please specify)
*
6.
Are you willing/able to:
(Required.)
Yes
No
Speak and write proficiently in English
Yes
No
See clearly (normally or with contacts/glasses)
Yes
No
Use both hands and feet fully
Yes
No
Perform non-strenuous actions in a furnished space
Yes
No
Eat different types of food as part of the study. Foods eaten will range from soft (yogurt) to hard (almonds/chips)
Yes
No
Put on and wear various accessories such as hats, watches, scarves, headphones, bracelets, necklaces
Yes
No
Lift light fitness weights that are approx. 1-2 lbs?
Yes
No
*
7.
Do any of the following apply to you?
(Required.)
You have any current hand, wrist, arm, shoulder, elbow, back, leg, ankle, or foot pain or injuries
You have any other condition that would prevent you from safely and comfortably walking around your home (including stairs).
You have skin conditions on either wrist which could prevent you from wearing a wristband on either wrist.
You have a pacemaker or any other implanted medical device which could be interfered with by wearing a study phone on your chest.
You have a weakened immune system due to illness or medical treatment.
You have experienced acute gastrointestinal symptoms within the past 48 hours.
You have been diagnosed with Salmonella, E. Coli, Norovirus, Hepatitis A, Shigella, or any other communicable disease transmissible through food within the last month.
You have current knee pain or have had a knee replacement.
You have current hip pain or had a hip replacement.
You have current extremity or joint injuries (i.e. - knee, ankle, hip, leg, shoulder, arm, wrist).
You have previous or current injury that actively limits current range of motion.
You have current back injury or pain.
You have current hand or arm injury or pain.
You have current neck injuries.
You have current pain that could be worsened by any exercise.
None of these apply to me
*
8.
Are you currently:
(Required.)
Employed full-time
Employed part-time
Unemployed
Self-employed
Student
Homemaker
Military
Retired
Unable to work
*
9.
Do you or does anyone in your family work for any of the following companies now or as your / their most recent employer:
SAMSUNG, AMAZON, APPLE, IBM, GOOGLE, FACEBOOK/META, MICROSOFT, HUAWEI, DELL, XIAMOI, HP, OPPO, ACER, ASUS, LENOVO, HTC, SONY, FOXCONN, CISCO, ORACLE
(Required.)
Yes, I or a member of my family have worked for one of these companies
No
*
10.
Do any of the following apply to you currently?
(Required.)
Use an electric wheelchair
Use a manual wheelchair
Use a cane to walk
Use crutches to walk
Use a walker to walk
Have a limp
NONE OF THESE
