Consumer Panel Screener
Contact Information
Full Name
Email Address
Phone Number
Demographics
Age
Gender
Male
Female
Other
Prefer not to say
Location (City, State)
Occupation
Screening Questions
Do you currently use [Product/Service Category]?
Yes
No
How often do you purchase [Product/Service Category]?
Weekly
Monthly
Rarely
Which of the following brands do you buy? (Select all that apply)
Brand 1
Brand 2
Brand 3
None of the above
Additional Comments
Please share your thoughts or experience with [Product/Service Category]