Name: *
Age:
Gender:
Contact number:
Email address: *
Q1. Do you have any existing medical conditions? If yes, please specify.
Q2. Have you previously participated in a clinical trial? If yes, please provide details.
Q3. Are you interested in participating in a clinical trial? * YesNo
Q4. If yes, what is the primary reason for your interest in participating?
Q5. Are you currently seeking treatment for a specific medical condition? If yes, please specify.
Q6. Are you open to participating in trials for different medical conditions? * YesNo
Q7. What type of clinical trial are you most interested in? * Drug trialsDevice trialsBehavioral trialsOther (please specify below)
Other clinical trials:
Q8. Are you comfortable with randomized trials where you may receive a placebo? * YesNo
Q9. What is your preferred trial duration? * Short-termMedium-termLong-term
Q10. Are you open to trials that require regular visits to a research site or hospital? * YesNo
Q11. How do you learn about clinical trials? * Healthcare providerOnline searchAdvertisementReferralOther (please specify below)
Other ways:
Q12. Which sources do you find most reliable for obtaining information about clinical trials? * DoctorsNursesPharmacistsOfficial websitesPatient advocacy groupsOther (please specify below)
Other sources:
Disclaimer: Your privacy is important to us. The information you provide in this questionnaire will be treated with utmost confidentiality and used solely for the purpose of understanding your needs and improving our services. Your data will not be shared with any third parties without your consent. By proceeding with this questionnaire, you acknowledge and agree to our data privacy practices. If you have any concerns, please contact us at [email protected] I acknowledge and agree.
Δ
Name of the organization: *
Position / title within the organization:
Q1. Briefly describe the type of clinical trials your organization conducts? *
Q2. How many clinical trials does your organization typically run in a year?
Q3. What strategies or channels have been most successful in recruiting participants for your clinical trials? *
Q4. What are the most significant challenges your organization faces when it comes to recruiting participants for clinical trials? *
Q5. Are there specific types of clinical trials or medical conditions that pose greater recruitment challenges than others? If yes, please specify.
Q6. Have you faced any recruitment challenges related to reaching diverse or underrepresented populations? If yes, please provide details.
Q7. Who is your target audience for clinical trial recruitment? Select all that apply. Patients with a specific medical conditionHealthy volunteersSpecific demographic groupsOther (please specify below)
Other target audiences:
Q8. How do you typically reach out to potential participants? Select all that apply. Online advertisingHealthcare provider referralsPatient advocacy groupsCommunity outreachOther (please specify below)
Other:
Q9. Do you provide any incentives or compensation to participants? If yes, please describe.
Q10. Have you collaborated with external organizations or partners to enhance participant recruitment efforts? If yes, please provide examples.
Q11. How would you prefer to be contacted for further discussions or follow-up regarding recruitment challenges? (Phone, email, in-person)
Q12. Is there a specific time frame that works best for you to discuss recruitment challenges?
Your Name: *
Name of the pharmacy: *
Position / title within the pharmacy: *
Email address:
Q1. Are you interested in innovative or alternative methods that would provide additional revenue for your pharmacy? If yes, please describe.
Q2. Have you collaborated with external organizations or partners to enhance participant experience at your pharmacy? If yes, please provide examples.
Q3. Are there any potential collaboration opportunities you would be interested in exploring to increase foot traffic at your pharmacy? If yes, please specify.
Q4. Would you be interested in getting any incentives or compensation for educating patients about clinical trials?
Q5. Is there a specific time frame that works best for you to discuss about the earning opportunity that PharmaPAIR offers?
