Participate

If you are interested in participating in usability studies, product evaluations, surveys or focus groups, please take about 5 minutes to fill out our Participant Background Questionnaire.

Any information provided is stored in a database owned and maintained solely by HumanCentric. You will not receive unsolicited email from third parties as a result of information you provide.

Please provide an email address that you check frequently because our studies fill quickly.

Participant Background Questionnaire

All of our research is conducted in the Raleigh-Durham area of North Carolina and in the Chicago (O'Hare) area.

Do you live close to our office in Cary, North Carolina?

Yes
No

Contact Information

First Name
Home Phone
Mobile Phone

Last Name
Work Phone

Address 1
Address 2

City
Zip Code

State
Country

Personal Information

Gender:

Male
Female

Year of Birth (do not enter complete DOB):

Height:

Dominant Hand:

Right
Left
Ambidextrious

What is your highest level of education completed?

Grade School
Some High School
Completed High School / GED
Completed vocational or technical degree
Some college
4 year college degree
Some post graduate college
Master's degree
Doctorate

Occupational Information

What is your job title, occupation, or major field of study?

In what industry do you work?

What is the name of your company or school?

Are you a business owner?

Yes
No

Number of Employees:

Are you in the medical field?

Yes
No

If you are in the medical field, what is your occupation?

Nurse
EMT
MD
Pharmacist
Other

Other Information

What is your primary email address?

What is your secondary email address?