Flu iiq

Registration Form

The flu-iiQTM questionnaire is copyright and may only be used with  permission from MESH.

Once registration is complete, and the use of the questionnaire has been clarified, a Licence Agreement and Fee Quotation will be provided for your review. The flu-iiQTM can only be used once the licence agreement has been fully executed and the licence fee paid in full.

  • A separate licence is required for each study.
  • Obtaining a fully executed license to use flu-iiQTM entitles you to use the questionnaire as published for the prescribed registered project only.
  • International copyright laws prohibit modification of the flu-iiQTM questions, item stems or item responses, or the omission of any of the flu-iiQTM questions. Flu-iiQTM questionnaires must be used and scored as prescribed.
  • A database of registered users is maintained to ensure that copyright is not breached.
  • The licence fee includes use of any of the existing flu-iiQTM translations.
  • New translations of the flu-iiQTM  can only be undertaken through MESH.
  • Users are advised to build a flu-iiQ™ data management system that conforms to the Clinical Data Interchange Standards (CDISC). MESH P/L will provide guidelines based on a Study Data Tabulation Model Implementation Guide domain model.

Please fill in the requested information (all fields must be completed):

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

3. Primary contact person:

4. Primary sponsor of the project:

14. Method of delivery of the flu-iiQTM (select):

15. Are you willing to have the information provided on this form made available in reports on the use and application of the flu-iiQTM?:

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