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?

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* 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)

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

Name

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* 3. Name

Gender

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* 4. Gender

Ethnicity

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* 5. Ethnicity

Do you speak a language in addition to English?

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

Birthdate

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* 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.

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* 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

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* 9. Address

Telephone Number

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* 10. Telephone Number

Maritial Status

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* 11. Maritial Status

Do you own or rent your primary residence?

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

Please provide us with information about your voter registration

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

Birthdates of your child(ren)

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* 15. Birthdates of your child(ren)

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

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* 16. Current employment status

Current job title

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* 17. Current job title

Current employer

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* 18. Current employer

Company size of current employer (all locations)

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* 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.

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* 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?

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* 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)?

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* 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)

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* 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)

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* 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)

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

To what extent do you agree or disagree with each of the following statements?

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* 27. To what extent do you agree or disagree with each of the following statements?

  Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
It is important to have a relationship with the pharmacist.
It is much easier to fill prescriptions at the grocery store (or other places I shop regularly) than to fill them at the drug store.
I am always willing to put in the extra time to make sure I find the best promotion or price.
I enjoy searching store circulars to find the best deals.
I worry about managing the out-of-pocket cost of prescriptions.
How much do you agree or disagree with each of the following statements?

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* 28. How much do you agree or disagree with each of the following statements?

  Agree Mostly Agree Somewhat Disagree Somewhat Disagree Mostly
My medical conditions limit my lifestyle somewhat.
I consult my pharmacist for health advice.
I am happy with my weight.
Price is more important to me than brand names.
I am willing to pay more for better quality.
Which of these items do you personally use? (Please check as many or as few apply to you)

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* 29. Which of these items do you personally use? (Please check as many or as few apply to you)

Which of the following social media sites/applications do you use? (Please check as many or as few apply to you)

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* 30. Which of the following social media sites/applications do you use? (Please check as many or as few apply to you)

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

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* 31. 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)

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* 32. 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?

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* 33. 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.

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* 34. 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.

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