Nicotine Study

First name

Last name

Address

City

State

Zip code

Birthday

Phone

Occupation

What company do you work for?

Ethnic Background

Marital Status

Highest Level of Education completed?

Income Level

When did you last participate in a group discussion or interview about a particular product or service?

What was the topic of your most recent research study you participated in?

Do you have any of the following medical conditions? * Required

Arthritis

Neck/back problems

Cancer

Chronic cold or sinus condition

Emphysema or any lung disease

Heart disease or any heart health issue

Throat/larynx issues

None

Which of the following products do you currently use on a regular basis? * Required

Tobacco/nicotine products

Castor oil

Mouthwash

E-cigarettes/Vapor products

Clove oil

None

Did you use any of the following nicotine products in the past 7 days * Required

Cigarettes / Factory-made Cigarettes

Moist Snuff (Dip / Chew):

Vapor / E-cigarettes:

Nicotine Pouches:

None

Which one of the following would you consider to be your primary nicotine-containing product? * Required

Cigarettes

Moist Snuff (Dip / Chew):

Nicotine Pouches

Disposable Vapor:

E-cigarette with pre-filled pods/cartridges

Tank/Modular Vapor:

None

Now, tell me about a new and exciting product that you have purchased or are wanting to purchase in the near future? - What made you want to purchase the product? - Who did you tell about it? - Did you post about it on social media? - What makes it different from similar products?

Thanks for applying for our research project! We'll get back to you if we can use you for the study!

Superior Recruiting LLC

sr.tampa@yahoo.com

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