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 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. INTRODUCTION
We are currently conducting a market research study on Hepatitis Delta/HDV and we are really interested in learning what life is like living with Hepatitis. As a result, we are looking for people to take part in an online community and help us to understand the highs and lows of their life over a period of 6 months. However, we realize that 6 months is a very big commitment, so we’d ask you to take part for three months and see if you enjoy it – if you do, you can keep signing up for 3-month periods, and if you don’t enjoy it, you can drop out at any time. 

This research is being conducted on behalf of a pharmaceutical company who manufactures medicines and treatments for HBV/HDV to help them best understand how they can help patients such as yourself.   
 
The research will take the form of an online community that we would ask you to contribute approximately one hour every few weeks. You will be a part of this community with other individuals diagnosed with HBV/HDV, and your participation will be anonymous (using avatars and screen names). We will never ask / collect any personal sensitive information (e.g. ethnicity, religious belief, sexual orientation, medical records).  

The community will take place through an easily accessible online platform. There will be different tasks/activities designed to make your experience as smooth and enjoyable as possible. You can share as much or as little as you want about yourself and there may be other activities where you might get a chance to take part in too and, if you choose to, you could virtually meet other people like you and share your experiences. Taking this opportunity to have your voice heard would greatly help us further our research, and your participation would be hugely appreciated. 
 
With your consent you may be asked to record mini videos within the market research study.  

Data collected during the study could be included in an aggregated and anonymous publication (for example in a scientific or specific sector journal). 
 
Please be aware that ELMA RESEARCH adheres to ESOMAR's, BHBIA, ABPI and Data Protection Act (UK), Market Research Society, British Healthcare Business Intelligence Association (UK) and EphMRA's market research codes of ethics and conduct. The data collected will be treated in adherence with the current legislation on personal data protection and confidentiality, will only be used for internal and research purposes and have no promotional intent whatsoever.  If you wish to see it, we will be happy to supply a copy of the privacy policy that applies to your participation in this market research study.

Does this sound like something you would be interested in?

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* 3. Online data and recordings: 
The online data and any interview we might agree to do would be audio and/or video recorded for market research and analysis purposes by members from the Elma Research team. For these purposes the recordings may be non-anonymized (non-voice distorted).  
 
Are you happy to participate on this basis?

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* 4. Adverse Event Reporting Patient Disclaimer: 
Different patients sometimes respond in different ways to the same medicine, and some side effects may not be discovered until many people have used a medicine over a period of time. For this reason, we are now required to pass on to our client, who is a manufacturer of medicines, details of any side effects or product 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 complaint when you, or someone you know, became ill after taking one of our client’s medicines, we will need to report this, so that they can learn more about the safety of their medicines. 
You have the right to refuse to answer questions or withdraw at any time, including at the end of the interview following disclosure of the sponsoring company’s name.   

Additionally, our client is required to report safety and adverse drug events information involving our products to the FDA upon becoming aware of such information. Therefore, we will forward any adverse event information immediately to their drug safety monitoring team. 

Are you happy to participate on this basis?

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* 5. Data protection 
We inform you that Elma will collect and process your personal data such as name, surname and email exclusively for market research purposes, through our online platform. The processing will take place within all security measures in accordance with UK Data Protection ACT 2018 and UK GDPR. For more information about your rights please see our privacy notice, it is available at https://www.elmaresearch.com/privacy-policy/ 
 
A specific consent will be asked when any videos, audios and pictures will be collected within the market research study. 

Are you happy to participate on this basis?

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* 6. CONSENT 
  • Your responses will be used by us and the sponsoring company for market research purposes only 
  • Your responses will be collated with other respondents and presented to the sponsor in aggregated or anonymized form 
  • Your responses will be sent to Fieldwork Agency by us and the sponsoring company for market research purposes only 
  • Exclusively under your consent, any videos, audios and pictures that may be collected during market research studies will be used solely in order to help members of the sponsoring pharmaceutical company to understand the research findings and will not be used in any promotional way 
  • Exclusively under your consent, any videos, audios and pictures that may be collected during market research studies will only be viewed by the following department/ roles: commercial, medical, legal, and public affairs, regulatory departments and executive teams. 
  • All those hearing/seeing these audios/videos/pictures agree to abide by the Market Research Society, ABPI, and all other relevant (e.g. BHBIA, EphMRA, CASRO, PMRG) Codes of Conduct for market research.

Do you agree to proceed with the research/ interview under these conditions? 

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* 7. Do you or a close member of your family work with a pharmaceutical company, market research agency or communications company?

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* 8. Have you been diagnosed with any of the following by a doctor? Select all that apply

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* 9. Because you will be making over $600 for this project, we will need you to sign a W9 form in order to process payment for the year of 2023. If you are a recurring participant, we may already have this from you. 

Are you happy to participate on this basis?

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