Sickle Cell Disease (SCD) Market Research Prequalifying Questionnaire

We are recruiting individuals/(caregivers of) individuals diagnosed with Sickle Cell Disease for a marketing research project on behalf of BluePrint Research Group; a firm that works with healthcare companies to help these companies better understand the experiences and opinions of people like you.

Since we are looking for many different varieties of people to participate in this research, I would like to ask you some general questions about your diagnosis. If you qualify for the study, you will be compensated (up to $150.00) for your time in participating in a 60-minute telephone/internet interview.

This project is purely concerned with marketing research and there will be no attempts to sell you anything or influence you in any way. All responses are entirely confidential and your identity will not be shared with the study sponsor. We ask that you answer the following questions as openly and freely as possible.

Different people sometimes respond in different ways to the same product, and some side effects may not be discovered until many people have used a product over a period of time. For this reason, we are required by law to pass on to our client details of any side effects or product technical complaints related to their own products that are mentioned during the course of market research.

Although what you say will, of course, be treated in confidence; should you mention during the discussion a side effect or product technical complaint when you, or someone you know, became ill after taking one of our client’s products, or a problem you have had with one of our client’s products we will need to report this, so that they can learn more about the safety of their products.

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* 1. Have you/(patient if caregiver) been diagnosed with Sickle Cell Disease?

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* 2. Age when diagnosed?

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* 3. If known please indicate the form of your SCD diagnosis:

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* 4. Please indicate treatments utilized, if any, for the treatment of SCD:

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* 5. Have you ever received Iron Chelation Therapy as part of your treatment?