Teeth Whitening Research

SIS International Research is looking for people to participate in a product test for a new teeth whitening device at the end of June in New York & New Jersey.

Participants will be compensated with a $100 gift card and a free Teeth Whitening Device to use and keep.

Please complete a short pre-screening survey to be considered for this project.

Question Title

* 1. What is your contact information?

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code

Email Address *

Phone Number *

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* 2. In the last 6 months, have you taken part in a focus group or market research study?

Yes

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* 3. Do you or anyone in your family work for:

A market research firm

A marketing/advertising organization

A publisher or newspaper

A dentist’s office

None of the above

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* 4. What is your gender?

Male

Female

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* 5. What is your age?

Under 21

21-34

35-44

45-54

55-64

65+

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* 6. What is your ethnicity?

Caucasian

African American

Hispanic/Latino

Asian American

Other (please specify)

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* 7. What is your current employment status?

Employed full time

Employed part time

Self employed

Homemaker

Currently looking for work/unemployed

Student

Other (please specify)

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* 8. Where do you currently live?

Manhattan

Brooklyn

Queens

Bronx

Staten Island

Westchester

New Jersey

Connecticut

Other

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* 9. What is your estimated annual household income?

$0-25k

$26-50k

$51-75k

$76-100k

$100k+

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* 10. What type of smartphone do you current own and use?

iPhone

Android

Windows Phone

Blackberry

I do not have a smartphone

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* 11. How much facial hair do you have?

None/clean shaven

Some facial hair

Significant facial hair

Facial hair but willing to clean shave

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* 12. Select a number that best matches the color of your teeth (from image below).

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* 13. Have you used teeth whitening products in the past (i.e., toothpastes, strips, gels, devices, etc.)?

Yes

No, but I am interested in using

I have not and would never use teeth whitening products

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* 14. Do you have, or are you susceptible to, tooth or gum sensitivity?

Yes

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* 15. Do your gums bleed when you brush your teeth, do they appear red and puffy, OR have you been diagnosed with gum disease by your dentist?

Yes

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* 16. Do you have any unnatural tooth surfaces (i.e., veneers, crowns, bridges, etc.) that show when you smile (e.g., in the front, top or bottom)?

Yes

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* 17. Are you willing and able to perform the whitening treatment of three consecutive 8-minute applications (24 minutes/day) for 7 consecutive days?

Yes

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* 18. Are you willing and able to visit a location near Penn Station in Manhattan on June 6th between 3pm-8pm and return to the same location in Manhattan 8 days later (June 14th)?

Yes

Thank you for your interest in our research! Our team will reach back to you soon.

Question Title

* 1. What is your contact information?

Question Title

* 2. In the last 6 months, have you taken part in a focus group or market research study?

Question Title

* 3. Do you or anyone in your family work for:

Question Title

* 4. What is your gender?

Question Title

* 5. What is your age?

Question Title

* 6. What is your ethnicity?

Question Title

* 7. What is your current employment status?

Question Title

* 8. Where do you currently live?

Question Title

* 9. What is your estimated annual household income?

Question Title

* 10. What type of smartphone do you current own and use?

Question Title

* 11. How much facial hair do you have?

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* 12. Select a number that best matches the color of your teeth (from image below).

Question Title

Question Title

* 13. Have you used teeth whitening products in the past (i.e., toothpastes, strips, gels, devices, etc.)?

Question Title

* 14. Do you have, or are you susceptible to, tooth or gum sensitivity?

Question Title

* 15. Do your gums bleed when you brush your teeth, do they appear red and puffy, OR have you been diagnosed with gum disease by your dentist?

Question Title

* 16. Do you have any unnatural tooth surfaces (i.e., veneers, crowns, bridges, etc.) that show when you smile (e.g., in the front, top or bottom)?

Question Title

* 17. Are you willing and able to perform the whitening treatment of three consecutive 8-minute applications (24 minutes/day) for 7 consecutive days?

Question Title

* 18. Are you willing and able to visit a location near Penn Station in Manhattan on June 6th between 3pm-8pm and return to the same location in Manhattan 8 days later (June 14th)?﻿

* 18. Are you willing and able to visit a location near Penn Station in Manhattan on June 6th between 3pm-8pm and return to the same location in Manhattan 8 days later (June 14th)?