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Thank you for your interest in the Hand Impairment Survey.

We are very interested in obtaining your opinion and experiences regarding Hand Impairment Survey. There will be no attempt to sell you anything or influence your medication choices in any way. Before you begin the survey, we will need a few pieces of information from you. Please complete the fields below to register and continue to the survey. If you qualify and complete the 30 minute online survey, you will earn SIP 60 for your participation.

 
SurveyRxTM.com uses a Secure signup process. Registration information is held in the strictest confidence.
 

What is our Secure Signup Process?

With our Secure Signup process:
  • You get a Sign-in name and password.
  • Your information is confidential: we will NEVER release your personal contact information.
  • The information is used to invite you to surveys and interactive learning programs for which you qualify, to verify you as the invited individual, and to process your honoraria.
  • You may elect to remove yourself from this database at any time.
Individual Information
Your Name:
First Name*
MI
Last Name*
Suffix
Date of Birth:
Month:
Date:
Year:
*
Gender: *
  Your email address is required to complete the registration process. Be sure to provide a valid email address that you use.
Email Id: *
  We use your e-mail address to send you invitations to participate in surveys and to deliver honorarium (in the form of an electronic gift certificate). If you select to receive a check, we will request your postal address after you have completed the survey.
Choose a Sign-in Name: *


      


   
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