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.

Have you registered as a participant with Intopia Connect? (required)

Your contact details
First name (required)
Last name (required)
Email (required)
Phone number (required)

Your experience
Do you currently have health insurance? (required)
Have you had health insurance in the past 12 months? (required)

Your personal details
I identify my gender as: (required)
Pronouns (optional)
Year of birth (YYYY) (required)
State or region (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
Do you have a laptop or desktop computer to use in your session? (required)
To participate, you will need to have access to a laptop or desktop computer.
What type of computer will you use? (required)
Do you use any assistive technology with your computer? (required)
What assistive technology do you often use?
Do you need any accommodations or adjustments to make the session comfortable and accessible for you? (Optional)
For example: captions, alternative communication methods, or other support.

Before you go…
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)