Registration form

Patient Registration

First Name
Surname
Address
Postcode
Mobile telephone number
Home telephone number
Email address
Occupation
Gender
Where did you
hear about us?



Other

 
Myself

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Other Condition(s):

Drug names
Year(s) diagnosed
Other adult in household

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Other Condition(s):

Drug names
Year(s) diagnosed
Child under 18 in household

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Other Condition(s):
Drug names
Year(s) diagnosed
Are there any other over-the-counter or prescribed medications that you take?
If you would like to add any further information or ask us any questions please use the box below.
We will contact you as soon as we are asked to conduct a study which relates to your profile. Many thanks.
   

What our clients say...

Richard Koban Payne

Adelphi Group

"The team did a fantastic job. You were most responsive to all of my requests, answered emails promptly, persevered with my anxieties, and got 60 completes and another 4 overquota. Just this morning came a follow-up RFP that requires yet another qualitative and quantitative sample in the UK (and a few other countries).
Because of your effort we can clearly demonstrate past performance in recruiting UK payers."

Read more testimonials

Recruiting
nationally for

Focus groups
Steering groups
Advisory boards
Workshops
Face to face depth interviews
Telephone interviews
Online surveys

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Our healthcare specialists include

GP's, GPwSI, Specialists and Surgeons, Key Opinion Leaders, Pharmacists, Nurses, PCT committee members, Heads of Medicines management, Prescribing & Commissioning Leads

See our full list of specialists

Quantitive and qualitative research resources

Booking of venues
Providing incentives
Interviews
Tailored requests
Questionnaires
Analysis and reports

Read more

Participate in paid market research

If you would like to register your interest to participate in paid market research please email or call us and we will contact you when there is an appropriate study.

Click here to apply