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Paid Research Study Survey - Forteo
*
1.
We are conducting a research study to evaluate new injection device concepts. You will be asked to evaluate concepts and provide feedback. You will
not
be asked to administer medication to yourself or anyone else. This is
not
a clinical trial.
The interview will last approximately
1 hour
and will be conducted in a one-on-one fashion with a study moderator. You will be paid
$175.00
for your time. Are you interested in taking this survey to see if you qualify for this study?
*Note- If it seems like you are a good fit for the study, someone will contact you after you complete this survey to be scheduled for the research study.
(Required.)
Yes
No
*
2.
What gender do you identify with?
(Required.)
Male
Female
Transgender male
Transgender female
Non-binary/non-confirming
Other
*
3.
How old are you?
(Required.)
*
4.
Have you been diagnosed with osteoporosis or osteopenia?
(Required.)
Yes
No
*
5.
Have you ever been prescribed Forteo to treat your osteoporosis or osteopenia (i.e., you had to inject yourself)?
(Required.)
Yes
No
*
6.
When was the last time you gave yourself an injection with your Forteo pen?
(Required.)
Currently using
Used within the past year
Used 1-2 years ago
Used 2-4 years ago
Used 5+ years ago
*
7.
What city are you located in?
(Required.)
*
8.
What state do you live in?
(Required.)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia (DC)
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
9.
Please enter your contact information below, along with your preferred method of contact.
(Required.)
Full Name
Email
Phone Number
Preferred contact method (call, text, or email)
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