Thank you for your interest in our upcoming study. Please fill out the following preliminary questions below. Once completed, if you qualify, we will follow up with you shortly after regarding your eligibility 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 Maggie at 847-373-4104 or email maggie@lagripperesearch.com 

Thank you!

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* 1. Please fill out the following contact information:

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* 2. ADVERSE EVENTS
We would like to reassure you that: 
  • We will comply with all laws protecting your personal data and the guidelines.
  • Your responses will be used by us and the sponsoring company for market research purposes only. 
  • Your responses will be collated with other participants and presented to the sponsor in aggregated or anonymized form.
  • The interview will be video recorded to help us with our analysis, and these videos may be released to the sponsor for their internal use only.
  • The interview is being observed by video link by representatives of the sponsor.
  • We are now being asked to pass on to our client details of adverse events that are mentioned during the course of market research. Although what you say will, of course, be treated in confidence, should you raise during the discussion an adverse event in a specific patient, we will need to report this even if it has already been reported by you directly to the company or the regulatory authorities using the normal reporting processes. 
  • In such a situation, you will be asked whether or not you are willing to waive the confidentiality given to you under the Market Research Codes of conduct specifically in relation to that adverse event. Everything else you say during the course of the interview will continue to remain confidential, and you will still have the option to remain anonymous if you so wish.
  • Your responses will be otherwise confidential and will not be used for any other purposes or disclosed to any third party without your approval. 
  • You have the right to withdraw from the interview at any time. 
Are you willing to participate with the interview on this basis?

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* 3. PERSONAL DATA CONSENT
I consent to the collection and processing of my personal data for the sole purpose of conducting marketing research. My personal data will only be associated to my responses for the duration of the study.

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* 4. Do you have a working webcam on your laptop/desktop computer?

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* 5. Do you have working headphones/earbuds with a microphone for your desktop/laptop that you would be able to use during the interview?

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* 6. To successfully participate in this discussion, you must have either a Chrome or Firefox browser installed on your computer. Which browser(s) do you currently have installed on your computer?

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* 7. Would you be willing to install either Chrome or FireFox browser on your computer if you dont have it already?

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* 8. When searching the internet for information on UC medications, which of the following devices do you primarily use? 

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* 9. When searching the internet for information about UC medications, how frequently do you start your research with a mobile phone, but eventually shift to a desktop computer?

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* 11. Which of the following do you feel comfortable doing on your smartphone? (select all that apply)

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* 12. Would you be willing to install DiscussIO, a research platform app on your phone?

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* 13. Have you participated in a marketing research study about Ulcerative Colitis in the past 3 months?

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* 14. What gender do you identify as?

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* 15. Which category best describes you?

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* 16. Are you, or any of your family members, currently employed or affiliated, or have ever been employed/ affiliated in the past, with any of the following?

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* 17. What month and year were you born? What is your current age?

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* 18. Are you currently be treated by your physician for any of the following?

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* 19. Approximately how long ago were you diagnosed with Ulcerative Colitis (UC)?

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* 20. Which type of healthcare professional(s) do you currently see for treatment of your Ulcerative Colitis (UC)?

Select all that apply

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* 21. On a scale of 0-10, with 0 being "Not at all severe" and 10 being "Extremely severe", how would you rate the severity of you Ulcerative Colitis in the past 6 months when it was at its worst?

0 - Not at all severe 5 10 - Extremely severe
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i We adjusted the number you entered based on the slider’s scale.

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* 22. How would you describe the severity of your Ulcerative Colitis (UC) at this point in time?

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* 23. Have you ever undergone surgery to treat your Ulcerative Colitis (UC)?

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* 24. Are you currently taking prescription medication(s) to treat your Ulcerative Colitis?

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* 25. Which, if any, of these UC treatments do you currently use or have previously used?

Steroids

  Have previously taken Currently taking Never taken
Oral prednisone or prednisolone
Oral budesonide (eg, UCERIS, Entocort® EC™)
Intravenous (IV) steroids
Rectal steroids
Other type of steroid 

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* 26. Which, if any, of these UC treatments do you currently use or have previously used?

Rectal Aminosalicylates (5-ASAs)

  Have previously taken Currently taking Never taken
mesalamine suppository or enema (eg, CANASA®, ROWASA®)
sulfasalazine suppository
Other rectal aminosalicylate

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* 27. Which, if any, of these UC treatments do you currently use or have previously used?

ORAL AMINOSALICYLATES (5-ASAs)

  Have previously taken Currently taking Never taken
APRISO® (mesalamine)
DELZICOL® (mesalamine)
LIALDA® (mesalamine)
PENTASA® (mesalamine)
AZULFIDINE® (sulfasalazine)
COLAZAL® (balsalazide)
GIAZO® (balsalazide)
Other oral aminosalicylate

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* 28. Which, if any, of these UC treatments do you currently use or have previously used?

IMMUNOMODULATORS / IMMUNOSUPPRESSANTS

  Have previously taken Currently taking Never taken
Cyclosporine (eg, Sandimmune®, Neoral®, Gengraf®)
AZASAN® (azathioprine)
IMURAN® (azathioprine)
Prograf® (tacrolimus)
PURINETHOL® (6-mercaptopurine or 6-MP)
Methotrexate (Rheumatrex®)
Other immunomodulator/immunosuppressant

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* 29. Which, if any, of these UC treatments do you currently use or have previously used?

BIOLOGICS/TARGETED THERAPY

  Have previously taken Currently taking Never taken
AMJEVITA™ (adalimumab-atto)
ENTYVIO® (vedolizumab)
HUMIRA® (adalimumab)
INFLECTRA™ (infliximab-dyyb)
IXIFI™ (infliximab-qbtx)
REMICADE® (infliximab)
RENFLEXIS™ (infliximab-abda)
SIMPONI® (golimumab)
STELARA® (ustekinumab)
XELJANZ® (tofacitinib)
Other biologics/targeted

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* 30. On a scale of 1 – 7, with 1 being “not at all satisfied”, 4 being “neutral” and 7 being “extremely satisfied”, how satisfied are you with your current treatment plan for UC? By current treatment plan, we are referring to the prescription medications, as well as any over the counter, diet, lifestyle or alternative therapy approaches you currently use to manage UC.?

1 - not at all satisfied 4 - neutral 7 - extremely satisfied
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i We adjusted the number you entered based on the slider’s scale.

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* 31. How often do you currently experience symptoms associated with your UC?

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* 32. In the past six months, have you taken steroids to treat your UC?

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* 33. Thinking back over the past six months, would you say that your UC symptoms have...

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* 34. On a scale of 1 – 7, with 1 being “Strongly Disagree”, 4 being “neutral” and 7 being “Strongly Agree”, please indicate how much you disagree or agree with the following statement: I wonder if switching to a different treatment would help me better control my UC.

1 - Strongly disagree 4 - Neutral 7 - Strongly agree
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i We adjusted the number you entered based on the slider’s scale.

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* 35. How much do you agree or disagree with the following statements about biologic medications to treat Ulcerative Colitis?

I think biologics are/may be a good treatment option for me. 

1 - Disagree Completely 4 - Neutral 7 - Agree completely
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i We adjusted the number you entered based on the slider’s scale.

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* 36. How much do you agree or disagree with the following statements?

I am determined to find a solution for my ulcerative colitis

1 - Disagree Completely 4 - Neutral 7 - Agree completely
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i We adjusted the number you entered based on the slider’s scale.

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* 37. How much do you agree or disagree with the following statements?

I am willing to try more aggressive treatments for my ulcerative colitis

1 - Disagree Completely 4 - Neutral 7 - Agree completely
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i We adjusted the number you entered based on the slider’s scale.

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* 38. How much do you agree or disagree with the following statements?

I am willing to try more aggressive treatments for my ulcerative colitis if it were a pill that I'd swallow once daily, that didn't have a lot of serious side effects or safety concerns that could affect me. 

1 - Disagree Completely 4 - Neutral 7 - Agree completely
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i We adjusted the number you entered based on the slider’s scale.

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* 39. How much do you agree or disagree with the following statements?

I do not feel like a productive member of society because of my ulcerative colitis.

1 - Disagree Completely 4 - Neutral 7 - Agree completely
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i We adjusted the number you entered based on the slider’s scale.

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* 40. Have you ever experience abdominal cramps or pain in the last month?

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* 41. Please use the scale below to indicate where you best fit on the continuum.

1 - I am comfortable trying new medications as soon as they are FDA approved 4 - Neutral 7 - I prefer to wait until a medication has been in the market for a while before trying it
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i We adjusted the number you entered based on the slider’s scale.

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* 42. Which of the following types of medical insurance do you currently have?

T