Skip to content

In-person Interviews on Grave's Disease/TED/Hyperthyroidism/MG

Screening Survey

Thank you for your interest in our upcoming study. Please fill out the following preliminary questions below. Once completed, we will follow up with you shortly after regarding your eligibility in the project and if qualified, to discuss details and scheduling. If you do not qualify, we will email you at the end of the project thanking you for your time and asking if you would be interested in future projects that you may qualify for.

If you have any questions, please contact Alex at 847-533-4052 or email alex@lagripperesearch.com.

Thank you!
1.Please fill out the following contact information:
2.LaGrippe Research is conducting this survey on behalf of Insight by Nemera, a research firm in Chicago. The purpose is to tell you about a study we’re conducting about people’s experiences with injections (of medication).

We’d like to ask you a few personal health and experience questions to see if you qualify to participate in a study during which participants will learn how to give an injection and give feedback about their experience. We would offer you an honorarium for participation. You don’t have to answer any questions you don’t want to answer.

All data collected is confidential and will be reported to an internal development team for the purpose of the study only. May I ask you a few preliminary questions to see if you qualify to participate?
3.What is your gender?
4.What is your birthdate? And what is your current age?
5.Are you right- or left-handed?
6.What is your highest achieved level of education?
7.What is your current occupation?
8.Have you ever been a healthcare professional or provided healthcare services as part of your occupation?
9.Do you, or does any member of your household, work for any of the following? (Select all that apply.)
10.Have you participated in any market research about an injection device in the past 6 months?
11.Have you been diagnosed with any chronic medical conditions?
12.Do you currently help care for someone with a medical condition?
Privacy & Cookie Notice