$125 Online Study Question Title * 1. Contact Info Name Phone E-Mail State Gender Age Question Title * 2. In the event that you mention a side effect (referred to as safety information) of a medication or device, we are required to pass the details of what happened to the safety department at the pharmaceutical company sponsoring the research and the FDA. In those situations, where you mention safety information, we need to know if you are willing to waive the confidentiality given to you under the Market Research Codes of Conduct, because we will need to collect personal dataa) Personal data (e.g. name, address, email, phone number) in relation to the safety information reported will be forwarded to the project sponsor; andb) The project sponsor will record and retain any safety information, including personal data related to safety information, in the sponsor’s global database for as long as required, and in the interests of patient safety and in compliance with all applicable global laws and regulations; andc) During the reporting of safety information, the project sponsor will not disclose such personal data to any un-associated third parties, with the exception of any disclosures required by applicable law, regulation or the order of a competent authority.Do you agree to waive the confidentiality given to you under the Market Research Codes of Conduct in relation to any safety information you report to us? If you agree, your contact details will be forwarded to the sponsor's Safety department for the express and sole purpose of follow-up of such report(s). Details of safety information may be reported to regulatory authorities along with your personal data. All other information provided by you in this study will remain confidential. If you prefer to preserve the confidentiality of this information, please select 'I do not agree'. If you do so, you can still participate in this survey. I agree - If you provide your email address during the reporting of safety information, this will not be linked to your responses given during the interview. I do not agree - If we become aware of safety information, we are obliged to report this to the pharmaceutical company. We will file this report without giving any of your details. Question Title * 3. Are you or any member of your immediate family currently employed by a pharmaceutical company, a government regulatory agency, or as a consultant to any pharmaceutical companies or market research, advertising, or public relations agencies? Yes No Question Title * 4. Which of the following best describes your gender identity? Male Female Non-binary/other Self Descriibe Next
