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* 1. Murray Hill National is seeking participants for a paid study, please fill out all the information below.

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* 2. Are you...

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* 3. May I have your age?

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* 4.  Are you, or any member of your household employed by a pharmaceutical/drug company on a full-time or consultancy basis, a government agency or regulatory body overseeing the pharmaceutical or healthcare industry, a marketing/market research company, or a communication, public relations, or advertising agency?

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* 5.  Which of the following best describes your menopausal status?

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* 6.  

Have you been diagnosed by a doctor with any of the following medical conditions?

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* 7.  Have you suffered any stress fractures or broken bones (other than fingers, toes, or skull) by tripping, or by falling from a standing position, since the onset of menopause?  If you have experienced a back or vertebrae fracture by tripping or falling from a standing position, please select “Yes.”

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* 8. Are you currently taking a prescription medication for your osteoporosis?

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* 9. For each of the following prescription medications, please indicate if you are currently using it to treat your osteoporosis? And if not, please indicate if you ever previously used it to treat your osteoporosis

  Currently Use Ever previously Used Never used
Fosamax, Fosamax + D (alendronate)
Generic alendronate (Generic Fosamax)
Actonel or generics (Risedronic acid)
Boniva Oral (Ibandronic acid)
Boniva infusion (IV) (Ibandronic acid)
Reclast (Zoledronic acid)
Generic zoledronic acid (generic Reclast)
Forteo (Teriparatide)
Prolia (Denosumab)
Tymlos (abaloparatide)
Evista (Raloxifene)
Any other prescription drugs (such as calcitonin, other hormone therapy)
No Rx therapy (can still be treated with Calcium and Vitamin D)

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* 10. . How would you describe your compliance with taking your medication? I usually don’t take my medication, I never take my medication

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* 11.   If your physician prescribed a medicine that would require you to use a needle and inject yourself, would you use the medication? 

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* 12. Are you allergic to latex?

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* 13. Are you allergic to any adhesive material?

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* 14. Please note that during the interview, you will be required to try on a few devices with adhesive to your stomach to simulate the wearing experience. Are you interested?

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