This questionnaire will put your information into the TE Connectivity (formerly Toolbox Medical Innovations) participant database. Please read the questions carefully and note that the order of the questions are for ease of use for the study recruiters. 

We respect your privacy and are committed to maintaining the accuracy, confidentiality, and security of your personal information. Any personal information you share with us is used strictly for study purposes ONLY and is not shared with any third party.
 
When a usability study comes up that matches your qualifications, we will send you information for that study. This information will not be shared with outside individuals or organizations. If you have any questions, please contact any one of the team members listed below. Thank you for your interest in supporting medical device research.

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* What type of user are you?

Home User:
Has no medical or laboratory training/experience

Lay User:
Works in a clinical setting where there are patients (E.g., Patient Services Specialists, Medical Office Receptionists, billing or other administrative roles)

Mid-Level Medical User:
E.g., Certified Nursing Assistants (CNAs), Licensed Vocational Nurses (LVNs), Nursing Students (NSs), Medical Assistants (MAs), Registered Nurses with a Diploma or an Associate Degree (RN-ADNs), Respiratory Therapists

High-Level Medical User:
E.g., Doctors (MDs/DOs), Nurse Practitioners (NPs), Physician’s Assistants (PAs), Registered Nurses with a Bachelor’s Degree or higher (RN-BSNs, RN-MSNs)

Lab Professional User:
E.g., Clinical Lab Scientists, Medical Lab Technicians

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* What is your gender?

Please put the following letters:

M = Male
F = Female
GNC = Gender Non-Conforming
Self-Identify (please specify)

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* What is your date of birth (MM/DD/YYYY)?

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* What is your age? Please put the number only (example = "34").

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* What is your ethnicity?

Please put the following letters:

NH = Non-Hispanic
H = Hispanic

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* What is your race? You may select more than one, if applicable. 

Please put the following letters:

A = Asian
W = White
B = Black/African American
Nh/Pi = Native Hawaiian/Pacific Islander
Ai/An = American Indian/Alaska Native 
Oth = Other

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* What is your highest level of education?

Please put the following letters:

SES = Some Elementary School
SMS = Some Middle School
SHS = Some High School
HS = Graduated High School
V = Vocational/ Trade School
SC = Some College
AD = Associate Degree
BD = Bachelor's Degree
M = Master's Degree
D = Doctorate (MD, PhD, EdD, etc.)

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* What is your dominant hand? 

Please put the following letters: 

R = Right
L = Left
Both

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* First Name:

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* Last Name:

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* Email address:

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* Phone Number (Please use this format) ###-###-####:

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* Who referred you to our Usability Studies or how did you hear about us?

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* May we text you study information?

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* Is there anything you would like us to know about your availability that would help us in communicating with you?

Example: "I am available after 12pm on weekdays."

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