Patient Community Survey

1
Do you consent to the information entered here being stored by Lindus Health, subject to the terms of our privacy policy, so that we can contact you about future research opportunities?* This field is required.You can unsubscribe at any time. We will never share your data without your explicit consent.
YESNO
2
Thank you! First up, what's your name?* This field is required.We need this so we know what to call you!
First Name
Last Name
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Next, what's your email address?* This field is required.We need this in order to contact you with personalised research opportunities.
example@example.com
Confirm Email
4
And your phone number?Your mobile number will only be shared with the research team to contact you about this study.
5
Many studies require participants within a specific age range. So that we can send you relevant studies, please select your year of birth.* This field is required.
2006
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Many trials require travel to a specific site. So that we can send you studies that are accessible, we need to know which major city you're closest to? Or would be willing to travel to.* This field is required.If your nearest city isn't listed please add it in Other! Please select all that apply.
London
Liverpool
Oxford
Cambridge
Southampton / Portsmouth
Manchester
Birmingham
Leeds
Newcastle
Edinburgh
Glasgow
Cardiff
Swansea
I live outside of the UK
Other
7
Some trials are specifically designed for a specific sex. What sex were you assigned at birth?* This field is required.If you feel that none of these match your description please add it in Other!
Male
Female
Non-binary / third gender
Prefer not to say
8
Some studies are looking to find participants from specific ethnic groups. So that we can send you the most relevant studies, we need to know how you would describe your ethnic group?* This field is required.If you feel that none of these match your description please add it in Other!
White
Black / African / Caribbean / Black British / African American
Mixed / Multiple ethnic group
Asian / Asian British
Hispanic / Latino
Arab
9
We need to know a bit about your health so that we can contact you about relevant research. Do you have any diagnosed medical conditions in the following areas?* This field is required.We need this to ensure that we only send you relevant research opportunities. Please select all that apply.
Dietary (e.g., Type 2 Diabetes, Obesity)
Circulatory system (e.g., high blood pressure, heart conditions, heart attack)
Digestive system (e.g., Crohn's disease, IBD, IBS)
Skin (e.g., Eczema, Acne)
Lungs and respiratory system (e.g., Asthma, COPD)
Allergies (e.g., Hay fever, Allergic Rhinitis)
Autoimmune disease (e.g., Type 1 diabetes, Rheumatoid arthritis, MS)
Liver, pancreas, and kidney conditions (e.g., NASH, fatty liver)
Mental health (e.g., depression, anxiety)
Current pregnancy (congratulations if so!)
Cancer
Musculoskeletal (e.g., arthritis, back pain, frailty)
Nervous system and brain (e.g., Parkinson’s, migraines, stroke)
Eyes and ears (e.g., visual impairment, deafness)
None of the above
Other
10
Digestive system: Please let us know which of these conditions you have been diagnosed with.This is optional.
IBD
IBS
Crohn's Disease
11
Dietary system: Please let us know which of these conditions you have been diagnosed with.This is optional.
Type 2 Diabetes
Obesity
12
Circulatory system: Please let us know which of these conditions you have been diagnosed with.This is optional.
High blood pressure (hypertension)
Heart condition
Heart failure
Heart attack, angina or coronary artery disease
13
Mental health: Please let us know which of these conditions you have been diagnosed with.This is optional.
Depression
Anxiety or generalised anxiety disorder
Panic attacks or panic disorder
Post-traumatic stress disorder (PTSD)
Attention deficit or attention deficit and hyperactivity disorder (ADD/ADHD)
Obsessive-compulsive disorder (OCD)
Mania, hypomania, bipolar or manic-depression
14
Autoimmune conditions: Please let us know which of these conditions you have been diagnosed with.This is optional.
Type 1 Diabetes
Multiple Sclerosis (MS)
Crohn's disease
Lupus (SLE)
Psoriasis
Reynaud's disease
Rheumatoid arthritis
Scleroderma
Ulcerative colitis
15
Nervous system and brain: Please let us know which of these conditions you have been diagnosed with.This is optional.
Amyotrophic lateral sclerosis (ALS)
Parkinson's disease
Migraines
Stroke or mini-stroke
Celebral Palsy
Fibromyalgia
16
Lung and respiratory system: Please let us know which of these conditions you have been diagnosed with.This is optional.
Asthma
COPD
Cystic Fibrosis
17
Eyes and Ears: Please let us know which of these conditions you have been diagnosed with.This is optional.
Blindness or vision impairment
Deafness
Cataracts
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Skin: Please let us know which of these conditions you have been diagnosed with.This is optional.
Skin
Acne
Vitiligo
19
Musculoskeletal: Please let us know which of these conditions you have been diagnosed with.This is optional.
Frailty
Arthritis
Bad back
20
Do you currently have cancer?This is optional.
No, cancer cured or in remission
Yes, currently receiving treatment
21
Please select all cancer sites that apply.This is optional.
Bladder
Bowel
Brain
Breast
Cervix
Head and Neck
Kidney
Leukaemia
Liver
Lung
Lymphoma
Melanoma Skin Cancer
Myeloma
Oesophagus
Pancreas
Prostate
Stomach
Thyroid
Uterus
22
Congratulations on your pregnancy! What is your estimated date of delivery?
Date
Day
Month
Year
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