Skip to content

In-Person Discussions with HCPs - Chicago, IL

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.What is your gender?
3.What is your birthdate? And your current age?
4.What is your current occupation?
5.How many years of experience do you have in your current role?
6.What specialty do you work in?
7.Please indicate if you, or any member of your household, work for any of the following. (Select all that apply.)
8.Have you participated in any market research about an injection device in the past 6 months?
9.Do you work with patients that have been diagnosed with Graves’ disease and/or Thyroid eye disease (TED)?
10.Do you regularly train patients or caregivers to use injection devices as part of your job?(Required.)
Privacy & Cookie Notice