Discussions on Health Condition(s)

1.Please fill out the following contact information:

First Name

Last Name

City

State

ZIP/Postal Code

Email Address

Phone Number

2.We are conducting this survey on behalf of BioVid, a medical marketing research firm. We are interested in speaking with people who are diagnosed with autoimmune diseases. Before we begin, I would like to reassure you that this study satisfies all requirements for a bona fide market research study; there will be absolutely no sales or promotional activities along with or consequent to the discussion. May I ask you a couple of quick questions to see if this study would be of interest to you?

Yes

No

3.The discussion will be audio/video recorded as well as observed/listened to live for future analysis by representatives from BioVid and the sponsoring organization. Those listening/watching or reviewing recordings must respect the confidentiality of all information exchanged in market research interviews/groups. No sales approaches will ever be made as a consequence of the organization having this access.

The recordings will be shared with the sponsoring organization and safely stored on secure servers and. All recordings are completely anonymous, and your identity will remain confidential. We fully comply with applicable data protection laws along with industry guidelines including, but not limited to; ESOMAR, EphMRA, BHBIA, Insights Association and all other relevant global codes of practice.

These recordings may be transcribed using BioVid's proprietary, completely in-house Artificial Intelligence (AI) tool. The transcription process adheres to strict privacy and data protection standards, ensuring that your identity remains confidential throughout the research process. Importantly, our AI is “closed” meaning no data is shared externally nor is it retained directly within these tools. The transcriptions produced are used solely for analysis and research purposes. This tool is specifically designed to ensure that any potential personal data is effectively removed, guaranteeing your full anonymity.

Do you consent to being observed/recorded under the conditions outlined above?

Yes, I consent to being observed/recorded and wish to participate in the interview

No, I do not consent to being observed/recorded and will not participate with the interview

4.BioVid is obligated to disclose any safety information collected to the sponsoring organization in order to comply with global regulatory agencies. Safety information can be any unexpected experience associated with the use of a medical product including Adverse Events (AE) and Product Quality Complaints (PQC). Adverse Events can be anything from a minor irritant (e.g., minor rash) to a more serious change in a person’s health (e.g., uncontrolled vomiting). Product Quality Complaints can be any deficiency with the product itself or its packaging (e.g., broken tablets, missing information card).

If you do disclose any safety information to us, the sponsoring organization may request to follow up to gain a better understanding of the reported event. If you consent, your contact information will only be used to help the sponsoring company comply with their obligations to global regulatory agencies. You may refuse to consent to having your personal information disclosed for this purpose and still take part in this study.

I understand the above safety reporting requirements consent to sharing my contact details with the sponsor for safety reporting follow up

I understand the above safety reporting requirements but do not consent to sharing my contact details with the sponsor.

5.In which state do you live?

6.What is your birthdate? And your current age?

Birthdate:

Current age:

7.What was your assigned sex at birth?

Male

Female

Discussions on Health Condition(s) - Patients

Screening Survey