Thank you for your interest in participating in a study!

The Henne Group is a market research company that has over 25 years of experience conducting focus group interviews and in-depth interviews. The topics of these interviews range from your health, your community, and the products or services you use.  Most studies we conduct offer a cash incentive for participation.

Because the studies that we conduct look for very specific types of people, we ask you to complete a short questionnaire.  The answers you give us will ensure that we can reach you when you fit the needs of a particular study.  All of your answers will remain confidential and will only be used for matching your profile to the needs of a study.

We do not share information with anyone.

All of your answers will remain confidential and will only be used for matching your profile to the needs of a study.

The Henne Group - Panel Database

All required information in Bold Red

Contact Information
How did you learn about this panel?
- Please Specify
First Name
Last Name
Day Phone 1 ( ) - ext
Evening Phone 1 ( ) -
Cell Phone 1 ( ) -
E-mail: (There will be specific studies to be completed over the internet. We will not be contacting you by e-mail except to invite you to a study or to make sure the e-mail address is still active.)
What is your computer connection speed? Dial-Up:     Broadband (DSL, Cable, T1):
Street Address:
City:
State:
Zip code:
What is the best day to reach you?
May we contact you during the weekend? Yes:     No:
What is the best time of day to reach you?
May we leave a message on your voicemail or answering machine? Yes:     No:
Personal Information
Gender:
Birth date:
Age:
What is the highest grade or level of education you have completed?
- if other please specify
Are you working...
If yes, what is your occupation?
What is your annual household income?
Which of the following categories best represents your race?
- if other please specify
What is your religious affiliation?
- if other please specify
What is your sexual orientation?
- if other please specify
What is your current relationship or marital status

Health Information
We do many studies related to health and wellness. The following is a list of specific health conditions that we conduct research on a regular basis. Please tell us if you have or have had any of the following health conditions.

Condition
Yes
No
Don't Know
Refuse
High Blood Pressure
High Cholesterol
Urination issues including frequent urination
Hernia
Low Back Pain
Erectile dysfunction (Male only)
- Premature ejaculation (Male only
Prostate issues, including BPH (Male only)
Gynecological Issues (Female Only)
If yes, please specify:
Bladder issues
Arthritis
Type I Diabetes
Type II Diabetes
Hepatitis
- If yes, please specify type:
Neurological issues
- If yes, please specify:
Cancer
-If yes, please specify:
Stroke
Heart issues
Cardiovascular Issues
HIV/AIDS
Other