DEFINE Pre-Screening Survey

1

Are you 18 years or older?* This field is required.This is a requirement to take part in the study.

YESNO

2

Have you experienced Tinnitus symptoms that have lasted at least 3 months?* This field is required.This is a requirement to take part in the study.

YESNO

3

Is Tinnitus frequently and significantly impacting your quality of life?* This field is required.This is a requirement to take part in the study.

YESNO

4

Have you received support to help you live with Tinnitus?* This field is required.For example, CBT.

YESNO

5

Do you have a smartphone with headphones?* This field is required.This will be required for taking part in the study.

YESNO

6

Do you consent to the information entered here being stored by Lindus Health, subject to the terms of our privacy policy, and being shared with the research team?* This field is required.This is required so that the study can contact you with further details about participation. We will never share your data without your explicit consent. We may contact you about relevant future research opportunities, and you can opt out of this at any time.

YESNO

7

What is your name?* This field is required.

First Name

Last Name

8

What is your preferred name?* This field is required.

9

What is your email address?* This field is required.

example@example.com

10

What is your phone number?* This field is required.Your mobile number will only be shared with the research team to contact you about this study.

11

Thank you for completing this survey! You're now ready to for the next step which is a call with the study nurse.

Please click "SUBMIT" and you will be redirected to Calendly to book a screening call with the study nurse.

If you have any questions, please email define@lindushealth.com
or call us on 0800 058 4496