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* 1. Murray Hill National, a market research company, will be in your area soon conducting PAID RESEARCH. We would like to invite you to receive notifications on all studies that might apply to you.  All of our research will pay you an incentive.  Cash and / or Rewards.   We will input your information into our database and contact you if you meet specific criteria.  To get started we require at a minimum your contact info.  We are asking a host of questions that will assist us in narrowing down which studies / research best suite your profile.  We are excited to work with you.

* 2. What is your profession?

* 3. In what industry do you work?

* 4. Which category below includes your age?

* 5. What is your gender?

* 6. What is your ethnicity?

* 7. Are you a Healthcare Professional? What is your specialty?

  Nurse CNA NP PA PCP Other Specialty I am not a healthcare professional
Yes
No

* 8. What is your specialty?

* 9. What is your approximate average household income?

* 10. What is your employment status?

* 11. Which of the following best describes your health insurance coverage?

* 12. Please pick all that apply

* 13. Do you own an above or in-ground swimming pool?

* 14. Please check any of the following that apply to you:

* 15. Please list the medications you are currently taking...

* 16. Check if you are a caregiver to someone being treated for any of the following

* 17. Have you ever been diagnosed with any of the following or had a diagnosis confirmed by a physician? Please select all that apply.

* 18. Have you ever been diagnosed with any of the following or had a diagnosis confirmed by a physician? Please select all that apply.

* 19. Do you use Snuff or Snus products?

* 20. Can you tell me which of the following products you use in your household?

* 21. Please list the ages of all people living in your household:

* 22. Do you experience pain in any of the following areas of your body:

* 23. Have you ever suffered a HEART ATTACK, and if so, how long ago?

* 24. We now require proof of diagnosis for all studies related to medical conditions. Are you willing to provide proof of medication and/or a doctor's note?

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