Thank you for your interest in participating in a user feedback session with Intopia Connect.

To help us find the right participants for this opportunity, please answer the following questions. It should only take 5-10 minutes.

Your responses will be kept private and used only for selecting participants for this study.

All fields are mandatory unless marked (Optional).

If you have any questions or need assistance completing this form, please email recruitment.connect@intopia.digital.

Your contact details
First name (required)
Last name (required)
Email (required)
Have you registered as a participant with Intopia Connect? (required)
Phone number (required)

Your personal details
I identify my gender as: (required)
Pronouns (optional)
Year of birth (YYYY) (required)
State or region (required)
Postcode (required)
Do you use a language other than English at home? (required)
What language do you speak at home? (required)

Your online shopping experience
Do you regularly shop for groceries online? (required)
Where do you usually do your grocery shopping online? (Select all that apply) (required)
Which device do you most often use for online grocery shopping? (Select one) (required)

Disability
Do you have a disability, impairment or chronic condition? (required)
Please select the disabilities and conditions that best match your experience (required)
Sensory disability (required)
Physical disability (required)
Intellectual impairment or cognitive disability (required)
Neurodivergent (required)
Mental or psychosocial disability (required)
Chronic condition or illness (required)

Technology usage
What devices do you use regularly? (required)
What assistive technology do you often use to access your devices? (Optional)
What other assistive devices or support do you use? (Optional)

Before you go…
To ensure you can participate fully and comfortably, are there any accommodations you would need for your session? (Optional) (required)
Would you like to be contacted about paid opportunities to provide feedback on specific websites and apps? (required)
How did you find out about this opportunity? (Optional)