ICON Post-Screening Visit Survey Demographic Information Thank you for screening at ICON. We are constantly striving to improve all aspects of your participation in our studies. We would appreciate if you take a few minutes to let us know how we are doing. Question Title * What is today's date? Date Date Question Title * What is your first and last name? (Optional.) Name Question Title * Do you want your responses to be anonymous if shared with ICON employees? Yes No Question Title * Are you male or female? Male Female Question Title * How old are you? 18-29 30-39 40-49 50-59 60-69 70-79 80+ Question Title * What is your home ZIP code? (Please enter a 5-digit ZIP code; for example, 84124) Question Title * What study did you screen for? Question Title * Have you previously participated in a study at ICON's clinic in Salt Lake City, UT? Yes No Question Title * Have you previously participated in a study at any other clinical research organization? Yes No Next
