*1.This survey is being conducted by an independent market research agency based in the US, on behalf of a pharmaceutical manufacturer.

We are conducting research on how people manage their health and illnesses. We are inviting individuals to participate in a one-on-one web-assisted telephone interview.

With your consent, your information will only be collected and used for market research and analysis. Any information you give will be treated in the strictest confidence and results will only be reported back on an aggregated basis.

The research will be conducted in accordance with all national data protection laws and relevant industry guidelines, including Insights Association, and all other relevant codes of conduct.

You have the right to withdraw from the interview at any time. For more information about your rights, please see our privacy notice, it is available at https://hawkpartners.com/privacy-statement/

Any information you give will be treated in the strictest confidence and results will only be reported back on an aggregated basis. You will receive an honorarium for your participation in survey once you pass the screening.

These discussions are being held strictly for research purposes; no sales of any kind. May I ask you a few questions to see if this study is appropriate for you?(Required.)

Yes

No

*2.We comply with privacy, data use, data protection and informed consent laws and regulations governing your personal information. This research will comply with Market Research industry guidelines. Any information you provide us with will be anonymized and you will remain anonymous unless you give permission to be identified. Your information will only be used for market research purposes. You have the right to refuse to answer questions or withdraw at any time.

Do you consent to proceed on this basis?(Required.)

Yes

No

*3.Contact Info(Required.)

Name

Phone

E-Mail

Gender

Age

State

*4.What is your current or previous...(Required.)

Occuptation

Industry