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Qualifying questions

Hello and thank you for your interest in our research project about people living with pain. To help us see if you qualify, please answer the questions below. We will follow up by phone to ensure that you match the study requirements. If chosen to participate, you will receive $75 to thank you for your time and opinions.

Please be reassured that all personal information collected in this survey will be used for this market research project only. You may withdraw your consent at any time by writing to info@hagensinclair.com or Hagen/Sinclair Research, 519 Reed Park Drive, Chico, CA 95926.

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* 1. Do you give your consent for us to have your personal information?

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* 2. When was the last time you participated in a market research project (i.e. focus group discussion or one-on-one interview)?

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* 3. What were the subjects of any focus group discussions or one-on-one interviews you participated in? (If none, write N/A)

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* 4. Which of the following ranges includes your age?

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* 5. What is your exact age?

We are seeking patients, caregivers, and healthcare clinicians to share their opinions about chronic pain. This survey contains three sets of questions to help us identify your role. You may fit more than one. Please answer all the questions.

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* 6. Have you previously been diagnosed with any of the following conditions/diseases? Please select all that apply.

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* 7. How many days in the last month were you unable to carry out some of your daily activities (like chores or job duties) because of a health condition or symptoms?

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* 8. Regarding your health condition, are you currently receiving treatment for your condition(s)?

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* 9. If you are getting treatment for one or more of the health conditions you mentioned, how well does treatment (or treatments) help you manage your health and wellbeing?

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* 10. How long have you had the condition? If you answered that you have more than one condition, think about the one you have been diagnosed with for the longest time.

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* 11. As someone with chronic pain, which of the following dates and times would you be available to participate in a virtual focus group? Select all that apply.

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* 12. Do you care for a family member who lives with pain? If you do, please say which family member, i.e., your parent, your spouse, your child, etc.

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* 13. What conditions/diseases does your loved one with pain have? (please select all that apply.)

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* 14. How long have you been providing care for your loved one with pain?

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* 15. How often do you provide care to your loved one with chronic pain?

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* 16. What types of support do you provide to your loved one with chronic pain?

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* 17. What challenges do you face as a caregiver for someone with chronic pain?

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* 18. As a caregiver, which of the following dates and times would you be available to participate in a virtual focus group? Select all that apply.

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* 19. If you currently work with patients who have chronic pain, which of the following best describes your profession?

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* 20. What is your medical specialty?

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* 21. Approximately how many years have you been practicing this profession?

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* 22. In what capacity have you worked with patients who have chronic pain? (Select all that apply)

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* 23. In which health care setting do you primarily work?

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* 24. To the best of your knowledge, which of the following best describes the race(s) of the patients who you work with most often? Choose all that apply.

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* 25. Which of the following dates and times would you be available to participate in a virtual focus group for clinicians? Select all that apply.

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* 26. Which of the following describes your race or ethnicity? Choose all that apply.

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* 27. Which of the following best represents how you think of yourself? Select one.

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* 28. How do you describe your gender?

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* 29. What is your actual job title/occupation?

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* 30. Which of the following best describes your annual household income?

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* 31. What city and state do you live in?

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* 32. In which geographic region do you live?

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* 33. Which of the following best describes the type of area where you live?

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* 34. What is your highest level of education?

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* 35. Do you have stable high-speed internet access?

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* 36. Which of the following do you have available to use for this session?

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* 37. How did you learn about this research?

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* 38. May we contact you in the future about other paid marketing research studies?

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* 39. We need to validate all participants. You will have an advantage if you copy and paste the web address / URL of your LinkedIn or other social media profile page here:

Thank you very much for answering all our questions!  The information you shared will be used for this study only. We will follow up with you by telephone if you match the study requirements.

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* 40. Please provide your contact information below.

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