Information Form for Academia or Not-For-Profit Use of the MFIQ

Our Solutions Clinical Development Real-World Evidence PPD Evidera Patient-Centered Research Clinical Outcome Assessment (COA) Instrument Management Services Migraine Functional Impact Questionnaire (MFIQ) Information Form for Academia or Not-For-Profit Use of the MFIQ

Please complete the form below to provide additional information about use of the MFIQ for academia or not-for-profit use and someone from our team will be in touch soon.

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Name*

First Last

Title / Degree*

Affiliation*

Company Department City State / Province / Region ZIP / Postal Code Country

Email Address*

Describe the planned study and use of the MFIQ*

Source of study funding*

What Language Versions do you require?*

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