Qualifying Questionnaire for HIV/AIDS Surveys

We are a branch of a larger market research company, whose goal is to make contact with individuals diagnosed with HIV/AIDS. In the coming months, we will reach out to those interested in participating in on-line surveys and/or telephone discussions to help understand the treatment decision process. When contacted and qualified we will pay respondents for their time (up to $100).

This project is solely concerned with marketing research and there will be no attempts to sell you anything or influence your pharmaceutical or treatment options in any way.

Our clients range from not-for-profit organizations, advertising agencies, advocacy groups and pharmaceutical companies. We work with them as an independent research company to gather the opinions of individuals closest to various disease groups. We have worked in a number of different disease areas including diabetes, autism, Fragile X, hemophilia and many more.

All information collected during the surveys or phone discussions will be completely confidential in that we will not show your name or any other identifying information to our clients.

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* 1. Are you a diagnosed HIV/AID's patient or caregiver of a diagnosed patient?

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* 2. Please identify which of the following “fixed-dose combination” medication(s) have/are you utilizing in the management of HIV/AIDS?

Select those that apply to current and past management.

  Current Past
Epzicom® or Kivexa®
None of the above

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* 3. Please provide basic information for us to contact you when telephone/internet survey is scheduled. Name, address and phone numbers are optional.

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