Nationwide - Patients

Plaza Research is currently recruiting for a Nationwide telephone survey.

The study will take place between Friday November 16 - Friday November 30 at various times.

If you qualify and participate for this study you would receive $75-100 for 1 hour of your time.

Please answer the questions below to see if you meet the specifications we are looking for.

Question Title

* 1. Contact Information

Name:

City/Town:

State:

Email Address:

Phone Number:

Question Title

* 2. Age

Question Title

* 3. Have you ever been diagnosed by a physician with any of these medical conditions?

Neurological impairment

Cystic Fibrosis

Functional Dyspepsia

Crohn's disease

Gastroesophageal Reflux disease

None of these

Question Title

* 4. What are the names of the medications you are currently taking for your symptoms?

Thank you for your time. If you meet the specifications we are looking for someone from Plaza Research Chicago will contact you to ask some additional questions and see if you can qualify for this study.

When you click Done you will be redirected to our Facebook Page. Facebook and Plaza Research are not, in any way, connected. You also do not need to be a Facebook member in order to qualify for the study that you just applied for. This is strictly a convenience if you, our respondent, would like to "like" our page as another avenue to be notified of upcoming groups.