Patient Panel

 
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1. Please fill in the information below.
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2. What is your gender?
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3. What is your current age?
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4. What is your marital status?
We are conducting a study to evaluate the usability and safety of a new device for injection a medication. I have a few questions I need answered to make sure you qualify.
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5. What is the highest grade level you achieved in an english-language school?
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6. Do you have at least one child between the ages of 2 and 17 living with you?
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7. How old is your child?
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8. Does your child receive daily injections of a growth hormone?
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