Houston Study - Immunoglobin Therapy

1. Introduction Section

Plaza Research Houston is conducting a discussion with those who live with or care for others who use Immunoglobin Therapy. The discussion will take place on Wednesday, July 26 or Thursday, July 27, 2017, time varies throughout the day. If you qualify and participate, you will $200 for 1.25-hours of your time.

Please answer the questions below. If you look like a match, we will contact you by telephone.

**Due to the large response to our surveys, we are only able to contact those that look like a match. Please continue to answer future studies, as you may be a match to those.

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* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

Name:

ZIP/Postal Code:

Email Address:

Phone Number:

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* 2. Alternate Contact number

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* 3. What is your age? Whole number, no ranges or words

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* 4. What is your gender?

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* 5. Do you personally or do any of your children, under the age of 18, currently living at home, use Immunoglobin therapy?

I use Immunoglobin

My child uses Immunoglobin

Someone else in the household uses Immunoglobin

No one in the household uses Immunoglobin