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 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 47-373-4104 or email maggie@lagripperesearch.com 

Thank you!

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* 1. Please fill out the following contact information:

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* 2. Gender

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

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* 4. Which of the following, if any, have you ever been diagnosed with by a doctor?

Select all that apply

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* 5. Which of the following treatments are you currently taking to treat your endometriosis? Please think about treatments used to treat the condition or manage symptoms, and not medications used only for birth control purposes or to address pain after surgical procedures.

Select all that apply

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* 6. Have you ever used Orilissa (elagolix) in the past to treat your Endometriosis?

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* 7. What dose of Orilissa (elagolix) have you used?

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* 8. How many times a day are you/were you taking Orilissa (elagolix)?

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* 9. If you have taken Orilissa (elagolix) in the past: To the best of your knowledge, roughly, how many months ago did you stop using Orilissa (elagolix)?

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* 10. Have you ever stopped using Orilissa (elagolix) for at least 30 days and re-started?

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* 11. If you have used Orilissa (elagolix) in the past and/or stopped and re-started Orilissa (elagolix): What were the reasons you stopped using Orilissa (elagolix)

Select all that apply

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* 12. If you discontinued Orilissa (elagolix) due to a surgical procedure. What was the surgical procedure you had?

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* 13. If you stopped using Orilissa (elagolix) due to a surgical procedure:  Did you…?

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* 14. If you are currently on Orilissa (elagolix): How satisfied are you with Orilissa (elagolix) for treating your endometriosis?

If you were previously on Orilissa (elagolix): How satisfied were you with Orilissa (elagolix) for treating your endometriosis?

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* 15. If you are currently on Orilissa (elagolix): To the best of your knowledge, for how many months have you been using Orilissa (elagolix), roughly?

If you were previously on Orilissa (elagolix): To the best of your knowledge, for how many months did you use Orilissa (elagolix), roughly?

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* 16. Now, we have a few final questions for classification purposes. First, which of the following best describes your race or ethnic background?

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* 17. For 2019, what was your household’s total income, before taxes?

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* 18. For classification purposes, how do you normally pay for your prescription medications?

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* 19. Now I’d like you to use your imagination. Every place in the world has a personality. What place best matches your own personality?  I do not mean the place you would want to visit or a place in the world you like, but I am talking about a place that is most like you.

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* 20. Again this project will consist of a 60-minute video interview that will take place between October 8th to October 13th. Could we schedule 60 minutes with you for you that week?

One important note for the interview: Please keep in mind that to participate you will need access to a laptop or desktop computer with a webcam for a video interview and make sure you are in a quiet, well-lit setting. Also, the discussion will be video-recorded but the videos will be confidential and are for research purposes only. Is this something you are willing and able to do?

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* 21. Please select all of the following dates and times in which you may be available for this 60 minute discussion. We will confirm a date and time via phone call. Please keep in mind these times are in Pacific Standard Time (PST)

Select all that you would be available for

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