Retinal Eye Disease - Market Research

We are a branch of a larger market research company, whose goal is to make contact with individuals diagnosed with "Retinal Eye Disease". In the coming weeks, we will reach out to those interested in participating in on-line surveys or telephone discussions to help understand the treatment decision process. When contacted and qualified we will pay respondents for their time (up to $100).

This project is solely concerned with marketing research and there will be no attempts to sell you anything or influence your pharmaceutical or treatment options in any way.

Our clients range from not-for-profit organizations, advertising agencies, advocacy groups and pharmaceutical companies. We work with them as an independent research company to gather the opinions of individuals closest to various disease groups. We have worked in a number of different disease areas including diabetes, autism, Fragile X, hemophilia and many more.

All information collected during the questionnaire or phone discussions will be completely confidential in that we will not show your name or any other identifying information to our clients.

Question Title

* 1. Are you the patient or caregiver?

Diagnosed Patient

Caregiver of Diagnosed Patient

Question Title

* 2. Has a “Retinal Eye Disease” been diagnosed by a physician?

YES

Question Title

* 3. The "Retinal Eye Disease" diagnosed is:

Wet age-related macula degeneration (AMD)

Dry age-related macula degeneration (AMD)

Geographic atrophy (GA)

Retinal vein occlusion (RVO)

Diabetic retinopathy (DR)

Diabetic macula edema (DME)

Other

Other (please specify)

Question Title

* 4. The following treatment(s) have been prescribed by my physician -

Steroids

Laser

Avastin

Lucentis

Eylea

Other (please specify medications if prescribed)

Question Title

* 5. Please provide information for us to contact you when telephone/internet interview is scheduled. Name, address and phone numbers are optional.

Name:

City/Town:

State:

ZIP:

Country:

Email Address: *

Phone Number:

Thank you very much for taking the time to fill out this short qualifying questionnaire. We are collecting basic information to match individuals with specific interview requirements in order to invite your valued participation.