-Health Conditions Study - OR
We like to keep our surveys short and sweet. You can rest assured that all of your information will be kept private and only used for our market research purposes.
Contact & Basic Info
First Name
Last Name
Email
Phone Number
Gender
Please select...
Female
Male
Transgender
Birthdate (mm/dd/yyyy)
Ethnicity
Please select...
African American or Black
American Indian or Alaska Native
Asian American
Caucasian or White
Hispanic, Latino or Spanish Origin
Native Hawaiian or Pacific Islander
Other
Location
City
State
Zip Code
Metro Area
Please select...
Atlanta-Sandy Springs-Roswell, GA
Austin-Round Rock, TX
Boston-Cambridge-Newton, MA-NH
Charlotte-Concord-Gastonia, NC-SC
Chicago-Naperville-Elgin, IL-IN-WI
Cincinnati, OH-KY-IN
Dallas-Fort Worth-Arlington, TX
Denver-Aurora-Lakewood, CO
Detroit-Warren-Dearborn, MI
Houston-The Woodlands-Sugar Land, TX
Los Angeles-Long Beach-Anaheim, CA
Miami-Fort Lauderdale-West Palm Beach, FL
Milwaukee-Waukesha-West Allis, WI
Minneapolis-St. Paul-Bloomington, MN-WI
Nashville-Davidson–Murfreesboro–Franklin, TN
New York-Newark-Jersey City, NY-NJ-PA
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD
Phoenix-Mesa-Scottsdale, AZ
Portland-Vancouver-Hillsboro, OR-WA
Sacramento–Roseville–Arden-Arcade, CA
San Antonio-New Braunfels, TX
San Diego-Carlsbad, CA
San Francisco–Oakland–Hayward, CA
San Jose-Sunnyvale-Santa Clara, CA
Seattle-Tacoma-Bellevue, WA
St. Louis, MO-IL
OTHER
We are currently conducting several
Paid Research Studies
in the Portland metro-area. Please fill out the answers below as truthfully as possible and then we'll give you a call, if you are a good fit!
What is your age?
Do you have children under the age of 18 living in your household?
Yes
No
What are their ages?
Do you currently have any of the following apps installed on your phone?
Facebook
Netflix
Instagram
Snapchat
Hulu
Twitter
Whatsapp
Health Insurance Provider App
Car Insurance Provider App
None of the above
Which ways do you use Instagram? Select all that apply
Sharing posts to my Story
Viewing other peoples stories
Direct messages
Posts to my Profile/Feed
Viewing other people’s posts / profile
Other
None of the above
Has your child ever been diagnosed with any of the following?
Diabetes
Atopic dermatitis or eczema
Psoriasis
Asthma
None of the above
Has your child used any of the following injection devices, within the past year, to
give an injection to him/herself?
Traditional syringe (draw up medicine from a vial before injecting)
Pre-filled Syringe (medicine is already in the syringe and syringe looks like a traditional syringe)
Pre-filled Pen or Auto-injector (device has medication already in it and user injects medicine by using a button or pressing down)
Multi-dose Pen (user uses the same device multiple times and has to change the needle each time)
EpiPen (epinephrine injection given in the past year)
Other
None of the above
Have you ever been diagnosed with any of the following?
Food allergies
Diabetes
Atopic dermatitis or eczema
Asthma
None of the above
Which of the following injection devices do you use (have you used) to give an injection to yourself or someone else?
Traditional syringe (draw up medicine from a vial before injecting)
Pre-filled Syringe (medicine is already in the syringe and syringe looks like a traditional syringe)
Pre-filled Pen or Autoinjector (device has medication already in it and user injects medicine by using a button or pressing down)
Multi-dose Pen (user uses the same device multiple times and has to change the needle and dial a dose each time)
EpiPen (epinephrine injection given in the past year)
Other
Do you follow any of the following lifestyles
Vegetarian Diet
Vegan Deit
Plant based Diet
Mediterranean Diet
Paleo Diet
None of the above
Ready to subm
it?
Contact Information