Obtain a confidential quotation for a flu-iiQ™ or RiiQ™ licence for your upcoming study by completing the form below.

All enquiries are strictly confidential.

Upon receipt of the completed form we will prepare a quotation based on the details you have provided and email this to you together with a copy of our Standard Licence Agreement.

We can also arrange for a teleconference with Dr Osborne, the author of the flu-iiQ™ and RiiQ™, to discuss the best use of the questionnaire for your study.

The flu-iiQ^TM / RiiQ^TM registration form

1. Name of your study or program

Study or program name - and any other relevant information, including registration number if known

2. Names of the Principal Investigators or Managers responsible for the investigation

Person 1

First Name

Last Name

Role in project

Person 2

First Name

Last Name

Role in project

Person 3

First Name

Last Name

Role in project

Person 4

First Name

Last Name

Role in project

Person 5

First Name

Last Name

Role in project

3. Primary contact person

Name

First Name

Last Name

Postal address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

4. Primary sponsor of the project

Organisation name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Website

http://

5. Study design details

Please select your study design?

If other, please specify

6. Program or study dates

Expected start date

YYYY

Expected finish date

YYYY

7. Respondent details

Anticipated number of respondents completing the questionnaire?

Number of times per day the respondent will complete the questionnaire?

Over how many days will the respondent complete the questionnaire?

Further details

8. Country and language details

List of countries the questionnaire will be administered in:

List of languages required:

9. Method of delivery

Method of delivery of flu-iiQ^TM

Paper

Telephone

ePRO

Other

If other, please specify

10. Terms of use

Are you willing to have the information provided on this form made available in reports on the use and application of the flu-iiQ^TM?

Yes

Are you willing to have the details you have provided on this form made available to other researchers or organisations working in similar fields?

Yes

flu-iiQ^TM / RiiQ^TM

Enquire about a licence

The flu-iiQ^TM / RiiQ^TM registration form

Terms of use | Privacy policy | © Measured Solutions for Health 2023.

Website by Hatch Labs.

flu-iiQTM / RiiQTM

Enquire about a licence

The flu-iiQTM / RiiQTM registration form

Terms of use | Privacy policy | © Measured Solutions for Health 2023.

Website by Hatch Labs.

flu-iiQ^TM / RiiQ^TM

The flu-iiQ^TM / RiiQ^TM registration form