MARKET RESEARCH – Project Multiple Sclerosis

We are looking for people who have been diagnosed with MS to take part in an interview for 1 hour in London or an interview in-home

Please answer the questions below.

Name:

Telephone number:

Home Postcode:

Work Postcode:

Age:

Ethnicity:

Nationality:

Occupation:

Job Title:

Industry sector:

Working status i.e. Full time, part time, etc..

Occupation of chief income earner in the household?

Who do you live with at home?

If you have children, please tell us their ages.

Which type of MS have you been diagnosed with?

• Relapse Remitting MS
• Primary Progressive MS
• Secondary Progressive MS with relapses
• Secondary Progressive MS without relapses
• Clinically isolated syndrome

How long ago were you diagnosed with MS?

Which of the following applies to you?

• I am currently taking a prescription medication
• I used to take medication for my MS but have now stopped
• I have never taken prescription medication for my MS but I would be willing to in the future
• I have never taken prescription medication for my MS and would never be willing to take medication

If you are taking medication for your MS, please tell us what medications you are currently taking

How long have you been taking medication for?

What is the highest level of education that you achieved?

Please forward this on to anyone you know who may be interested.

Unfortunately, it is impossible to reply to all emails or phone messages.   We receive lots of responses to researches that are emailed out. You will be contacted by phone if your application is successful. However, we apologise if you do not hear from us, but please keep trying for future projects that are sent out.

We look forward to hearing from you.
 
Kind regards,
 
 
Daliah Salem
trend MARKET RESEARCH LTD