InsightsRewards Panel Recruitment Form
1. Consent and Agreements
I agree to the terms and conditions of InsightsReward *
I have read and accept the privacy policy *
I consent to the processing and sharing of my data as described in the privacy policy *
I would like to receive newsletters and panel updates from InsightsReward (optional)
2. Personal Information
Full Name:
Date of Birth:
Gender:
Select
Male
Female
Non-binary
Prefer not to say
Email Address:
Password:
Confirm Password:
Phone Number:
Country of Residence:
Select your country
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Congo-Brazzaville)
Costa Rica
Croatia
Cuba
Cyprus
Czechia (Czech Republic)
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (fmr. Swaziland)
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (formerly Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine State
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
ZIP/Postal Code:
Annual Household Income Range:
Select
Under $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 - $249,999
$250,000 - $499,999
$500,000 - $999,999
$1,000,000 or more
3. Demographic Information
Marital Status:
Single
Married
Divorced
Widowed
In a relationship
Number of Children:
None
1
2
3
4 or more
Household Size:
1
2
3
4
5 or more
Highest Education Level:
High School or less
Some College
Bachelor's Degree
Master's Degree
Doctorate or higher
Employment Status:
Full-time employed
Part-time employed
Self-employed/Business Owner
Unemployed
Student
Retired
Job Details
Job Title:
Industry Sector:
Select Industry
Technology
Healthcare and Medicine
Financial Services
Manufacturing
Retail and E-commerce
Education
Hospitality and Tourism
Energy and Utilities
Real Estate
Transportation and Logistics
Agriculture
Media and Entertainment
Telecommunications
Construction
Automotive
Aerospace and Defense
Food and Beverage
Public Sector
Non-Profit Organizations
What is your primary role in the healthcare industry?
Choose
Physician
Nurse
Medical Technician
Administrator
Pharmacist
Dentist
Healthcare Consultant
Public Health Specialist
Allied Health Professional
Laboratory Technician
Researcher
Medical Educator
Other
What is your area of specialization or expertise?
Choose
General Medicine
Pediatrics
Surgery
Radiology
Cardiology
Neurology
Orthopedics
Psychiatry
Oncology
Dermatology
Gynecology/Obstetrics
Anesthesiology
Pathology
Emergency Medicine
Endocrinology
Gastroenterology
Urology
Pulmonology
Ophthalmology
Otolaryngology (ENT)
Other
What type of healthcare facility do you primarily work in?
Choose
Hospital
Clinic
Private Practice
Pharmacy
Nursing Home
Rehabilitation Center
Diagnostic Laboratory
Research Institution
Community Health Center
Telemedicine Service Provider
Academic Institution
Government/Public Health Organization
Other
How many beds are there in your healthcare facility?
Choose
0-10
11-25
26-50
51-100
More than 100
How many years of experience do you have in the healthcare industry?
Choose
Less than 1 year
1-5 years
6-10 years
More than 10 years
On average, how many patients do you interact with daily?
Select
Less than 10
10-20
21-50
More than 50
Do you use any healthcare technology platforms in your work?
Select
Yes
No
If yes, please specify:
How frequently do you participate in professional development or training programs?
Select
Monthly
Quarterly
Annually
Rarely
What do you consider the biggest challenge in your role?
Select
Patient Care
Administrative Burden
Resource Availability
Other
If "Other", please specify:
Are you involved in purchasing or decision-making for healthcare equipment or services?
Select
Yes
No
How do you stay updated with the latest advancements in healthcare?
Select
Medical Journals
Conferences and Seminars
Online Courses
Other
If "Other", please specify:
Would you be available for regular feedback or focus group discussions?
Select
Yes
No
Company Size:
Select Company Size
1-10 employees
11-50 employees
51-200 employees
201-500 employees
501-1000 employees
1001+ employees
Years in Current Role:
Select Years
Less than 1 year
1-3 years
4-6 years
7-10 years
10+ years
Primary Job Responsibilities (select all that apply):
Strategic planning
Financial management
Sales
Marketing
Operations
Human Resources
IT/Technology
Research & Development
Customer Service
Other
Level of Seniority:
Select Level
Entry-level
Mid-level
Senior-level
Executive/C-suite
Decision-Making Authority:
Select Authority
Final decision maker
Part of decision-making team
Influence decisions
No decision-making authority
Budget Responsibility:
Select Budget
No budget responsibility
Less than $10,000
$10,000 - $100,000
$100,001 - $1 million
Over $1 million
Self-Employed/Business Owner Details
Type of Business:
Sole proprietorship
Partnership
Limited Liability Company (LLC)
Corporation
Franchise
Other
Number of Employees:
Just me
2-5
6-20
21-50
51-200
201+
Years in Business:
Select Years
Less than 1 year
1-3 years
4-6 years
7-10 years
10+ years
Annual Revenue:
Select Range
Less than $100,000
$100,000 - $500,000
$500,001 - $1 million
$1 million - $5 million
$5 million - $10 million
$10 million+
Geographic Scope of Business:
Local
Regional
National
International
4. Technology and Consumer Behavior
Smartphone
Tablet
Laptop
Desktop computer
Smart TV
Smartwatch
Gaming console
Yes
No
Shared responsibility
Frequency of online shopping:
Choose
Daily
Weekly
Monthly
Rarely
Never
5. Travel and Leisure
Frequency of domestic travel:
Choose
Weekly
Monthly
A few times a year
Rarely
Never
Frequency of international travel:
Choose
Multiple times a year
Once a year
Every few years
Rarely
Never
6. Media Consumption
Cable/Satellite TV
Streaming services (Netflix, Hulu, etc.)
YouTube
Don't watch TV
Facebook
Instagram
Twitter
LinkedIn
TikTok
Pinterest
None
7.Health and Lifestyle
General health status:
Select
Excellent
Good
Fair
Poor
Do you have any chronic conditions or disabilities?
Select
Yes
No
Prefer not to say
Smoking status:
Select
Non-smoker
Former smoker
Current smoker
Alcohol consumption frequency:
Select
Daily
Weekly
Monthly
Rarely
Never
Exercise habits:
Select
Daily
3-5 times a week
1-2 times a week
Rarely
Never
Dietary preferences:
Select
No restrictions
Vegetarian
Vegan
Pescatarian
Gluten-free
Other
If "Other", please specify:
8. Survey Preferences
Preferred survey length:
Choose
Less than 5 minutes
5-10 minutes
11-20 minutes
20+ minutes
Online surveys
Phone interviews
Video interviews
In-person focus groups
Product testing
Preferred frequency of survey invitations:
Choose
Daily
Weekly
Bi-weekly
Monthly
9. Incentive Preferences
Cash
Gift cards
Charitable donations
Points redeemable for prizes
10. Additional Information
How did you hear about our panel?
Choose
Search engine
Social media
Friend/Family referral
Online advertisement
Other
Submit