Information Form for Pharmaceutical Company 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 Pharmaceutical Company Use of the MFIQ

Please complete the form below to provide additional information about use of the MFIQ for pharmaceutical companies and someone from our team will be in touch soon.

"*" indicates required fields

Name*

First Last

Title / Degree*

Affiliation*

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

Email Address*

If ePRO is planned, who will be your ePRO provider?*

Describe phase and type of study*

Describe the purpose of use for the MFIQ*

What Language Versions do you require?*

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