Information Form for Academic and Private Practice Use of the PSI

Our Solutions Clinical Development Real-World Evidence PPD Evidera Patient-Centered Research Clinical Outcome Assessment (COA) Instrument Management Services Psoriasis Symptom Inventory Information Form for Academic and Private Practice Use of the PSI

Please complete the form below to provide additional information about use of the PSI for academic and private practice and someone from our team will be in touch soon.

"*" indicates required fields

Name*

First Last

Title / Degree*

Affiliation*

Email Address*

Which version of the PSI are you interested in?*

Past 24-hour recall (accumulates 7 days to a weekly diary score)

Past 7 days recall (patient retrospective report to create a past week score)

Which mode of administration do you plan?*

Handheld ePRO device

Tablet

Web Based

BYOD (to include smart phone)

Paper/Pencil

Currently undecided

Describe the planned study and use of the PSI.*

Source of study funding?*

What Language Versions do you require?*

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