HOME
 
Nieto Consumer Panel Information Sheet
Flowery Branch, Ga 30542
 

Fill in the information below and then click the submit button.
 Parent/Guardian First/Last Name:       Date:   
 Street Address:   
 City:   State:  Zip: 
 Phone:     Alt.Phone:   
 Email:   
 
 Brand of Wipes Used Most Often:   Select One:   Huggies    Pampers    Whatever is on Sale    Store Brand    Other   
 
                  If Store Brand:      If Other:  
 
 Child #1 First Name:     Gender:   Boy    Girl  
 Birthday:     Weight(lbs):   
 Diaper Brand Used Most Often:   Select One:   Huggies    Luvs    Pampers    Whatever is on Sale    Store Brand    Other   
 
                  If Store Brand:      If Other:  
 Diaper Size:   Select One:   NB      1      2      3      4      5      6    
 Does Your Child Wear Training Pants?        Yes    No    TP Size:   
 
 Child #2 First Name:     Gender:   Boy    Girl  
 Birthday:     Weight(lbs):   
 Diaper Brand Used Most Often:   Select One:   Huggies    Luvs    Pampers    Whatever is on Sale    Store Brand    Other   
 
                  If Store Brand:      If Other:  
 Diaper Size:   Select One:   NB      1      2      3      4      5      6    
 Does Your Child Wear Training Pants?        Yes    No    TP Size:   
 
 Would you be interested in testing feminine care products?        Yes    No  
 If Yes, what do you use most often?        Pads    Tampons    Both  
 Tampon Type:        Cardboard    Plastic    Whatever is on Sale  
 Absorbancy:        Regular    Super  
 
 How did you learn about Nieto Research, Inc.
 And our consumer product surveys? 
   
 (Name, Phone Number or Internet Website name)
 
 Yes   I Accept the Terms of the Confidentiality Agreement

Please check that your email address is correct.
Our initial contact for Every study is via an email from Nieto Research, Inc.