Sign Up Sign Up to Participate in a Paid Research Study. Help improve the future of healthcare technology by sharing your experiences with us. Name * First Name Last Name Email * Mobile phone number * (###) ### #### How did you hear about us? Support Group Referral from a Healthcare Professional Referral from Friend or Family Member Google Search Social Media (Facebook, Instagram, etc.) Flyer Newspaper Ad TikTok Girls With Guts Gut It Out SPOHNC String Theory High School FindFocusGroups.com Craigslist Other Please enter the name of the person who referred you: What is your date of birth? * MM DD YYYY Gender * Male Female Non-binary Transgender Other Are you right-handed, left-handed, or ambidextrous Right Left Ambidextrous Please select if you are an HCP or Non HCP * Health Care Provider Non HCP Which of these best describe you (select all that apply)? * I am a Healthcare Professional I am diagnosed with a medical condition I care for someone with a medical condition None of above Do you have experience administering medication? Autoinjector Syringe and vial Prefilled syringe Prefilled pen On-body injector None What is your current occupation? Physician Physician Assistant Nurse Administrator Technician/Technologist Pharmacist Therapist Other Hospital Association What is your specialty (select all that apply)? Acute Care Acute Rehab Addictions Ambulatory Infusion Anesthesiology Bariatric Bone Marrow Transplant BSN Cardiac Cardiac Cath Lab Cardiac Surgery Cardiology Cardiothoracic Surgery Cataract Chronic pain management Clinical Colorectal Critical Care Dermatology Diabetes Dialysis Electrophysiology Emergency Medicine Endocrinology Endoscopy Unit/GI ENT ER Family Medicine First Responder Gastroenterology General Medicine General Surgery Geriatric Medicine Glaucoma Gynecology Gynecologic Oncology Hematology Hemodialysis Home Health Care Home Infusion Hospice Hospital Pharmacy Hypertension ICU Infectious Diseases Infusion Inpatient Interventional Cardiology Interventional Pulmonology Interventional Radiology Kidney Disease Labor and Delivery Long Term Care Maxillofacial Surgery MED/SURG Medical Director Metabolism Movement Disorders Multiple Sclerosis Neonatal ICU Nephrology Neurology Neurosurgery NICU Occupational Health Occupational Therapy Oncology Ophthalmology Optometry Oral Surgery OR Staff Orthopedic Otology Outpatient PACU Parkinson's Pathology Pediatric Perioperative Peritoneal Dialysis Plastic Surgery Post-operative medicine Primary Care Psychiatry Pulmonology Radiation Medicine Radiology Reconstructive Surgery Rehabilitation Renal Electrolyte Retail Retail Pharmacy Retina Rheumatology Specialty Pharmacy Sport Med Step Down Unit Sterilization Reprocessing Supervisor Surgical Oncology Telemetry Thoracic Surgery Transfusion Transplants Trauma Travel Medicine Urology VAD Coordinator Vascular Surgery What is your job title? Nurse Practitioner LPN/LVN Advanced Practice Nurse CNA Charge Nurse CRNA Allergist Allergist / Immunologist Ambulatory Infusion Anesthesiologist Assistant Specialist BSN Bariatric Surgeon Biomedical Engineer Biomedical Equipment Technician Biomedical Technician Blood Bank Manager CEO СМО CNO CPRP Cardiac Cath Lab Technician Cardiac Nurse Cardiologist Care Coordinator Care Manager Cath-lab Manager Certified Diabetes Educator Chief of Surgery Chiropractor Circulating Nurse Clinical Coordinator Clinical Engineer Clinical Engineering Technician Clinical Manager Care Clinical Nurse Clinical Researcher Clinical Services Coordinator Clinical Services Specialist Clinical Technician Clinical Therapist Clinician Colorectal Surgeon Counselor Dental Assistant Dermatologist Diabetologist Dialysis Nurse Dialysis Technician Dietitian Director of Clinical Research Director of Clinical Resources Director of Clinical Services Director of Interventional Services Director of Nursing Director of Pharmacy Director of Trauma EMT ENT EP Lab Manager ER Doctor ER Technician Electrophysiologist Endocrinologist Endovascular Surgeon Event Director Executive Director Extended Infusion Nurse Family Physician Field Service Engineer Fire Fighter Gastroenterologist General Counsel General Dentist General Practitioner General Surgeon Genetic Counselor Gynecological Surgeon HTC Director Healthcare Educator Hematologist Histotechnologist Home Health Aide Hygienist Immunologist Infusion Manager Institute Director Internal Medicine Physician Interventional Cardiologist Interventional Pulmonologist Interventional Radiologist LPN LVN Lab Assistant Laboratory Director Laboratory Manager Laboratory Supervisor Laboratory Technician MRI Technician MSN Manager of Training & Outreach Maxillofacial Surgeon Media/Communications Lead Medical Assistant Medical Director Medical Laboratory Scientist Medical Surgical Nurse Medical Technician Medical Technologist Microbiology Supervisor Microbiology Technologist Molecular Geneticist Nephrologist Neuroendovascular Surgeon Neurologist Neurosurgeon Nuclear Medicine Technologist Nurse Aide Nurse Case Manager Nurse Clinician Nurse Coordinator Nurse Educator Nurse Injector Nurse Manager Nurse Navigator Nurse Supervisor Nursing Care Technician Nursing Professional Development Specialist Nutritionist OBGYN Obstetrician and Gynecologists Occupational Therapist Office Administrator Office Manager Oncological Surgeon Oncologist Oncology Certified Nurse Ophthalmic Technician Ophthalmologist Orthopedic Surgeon Otolaryngologist Surgeon Paramedic Pathologist Patient Care Technician Pediatric Rheumatologist Pediatrician Perfusionist Pharmacist Pharmacy Director Pharmacy Head Pharmacy Technician Phlebotomist Physical Therapist Physician Physician Assistant Plastic Surgeon Point of Care Coordinator Police Officer Primary Care Physician Private Practice Physician Professor Program Coordinator Program Director Property Manager Psychiatrist Pulmonologist Purchasing Quality Assurance Manager RN Radiation Oncologist Radiation Therapist Radiologic Technologist Radiologist Radiology/Cardiology/Vascular Admin Research Coordinator Residency Manager Respiratory Therapist Rheumatologist Scrub Nurse Scrub Tech Social Worker Specialist Specimen Processor Speech Pathologist Speech-Language Pathologist Sterilization/Reprocessing Technician Supervisor Surgeon Surgical First Assistant Surgical Gastroenterologist Surgical Neurophysiologist Surgical Technician Surgical Technologist Teacher Technical Specialist Technician Telemetry Unit Testing Coordinator Therapist Transfusion Medicine Ultrasound Technician Urologist VAD Coordinator VP of Operations Vascular Surgeon Wound Care Therapist Other Do you have any of the following conditions (select all that apply)? Alzheimer's Disease Asthma Atopic Dermatitis Cancer Cerebral Palsy Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Chronic Spontaneous Urticaria Conditions that cause Seizures COPD Crohn's Disease Diabetes (Type 1) Diabetes (Type 2) Eosinophilic Duodenitis (EoD) Eosinophilic Esophagitis (EoE) Eosinophilic Gastritis (EoG) Heart Attack Hemophilia A/B Hereditary Angioedema High Blood Pressure High Cholesterol Huntington's Disease Hypoparathyroidism Juvenile Arthritis Kidney Disease Lupus Migraines Multiple Sclerosis Myasthenia Gravis (MG) Nasal Polyps Osteoarthritis Osteoporosis Parkinson's Disease Psoriasis Rheumatoid Arthritis Tardive Dyskinesia Ulcerative Colitis Other None Does the person you care for have any of the following conditions (select all that apply)? Alzheimer's Disease Asthma Atopic Dermatitis Cancer Cerebral Palsy Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Chronic Spontaneous Urticaria Conditions that cause Seizures COPD Crohn's Disease Diabetes (Type 1) Diabetes (Type 2) Eosinophilic Duodenitis (EoD) Eosinophilic Esophagitis (EoE) Eosinophilic Gastritis (EoG) Heart Attack Hemophilia A/B Hereditary Angioedema High Blood Pressure High Cholesterol Huntington's Disease Hypoparathyroidism Juvenile Arthritis Kidney Disease Lupus Migraines Multiple Sclerosis Myasthenia Gravis (MG) Nasal Polyps Osteoarthritis Osteoporosis Parkinson's Disease Psoriasis Rheumatoid Arthritis Tardive Dyskinesia Ulcerative Colitis Other None If you chose other in disease condition, please specify: What is the highest level of education that you have completed? Graduate Degree (Master's, Ph.D.) Some High School High School Diploma or GED Some College / Associate degree Bachelor's Degree Is the person you care for receiving (currently or in the past) any of the following forms of medication delivery? Chemotherapy Radiation Intravenous infusion (clinical setting) Intravenous infusion (home setting) Dialysis No Do you have a care partner or caregiver that you’d like to recommend for studies? A caregiver can include a spouse, partner, parent, child, or anyone familiar with your medical condition who helps care for you. Caregiver roles can include, but are not limited to, transportation to doctor’s appointments, medication administration assistance, and assisting with tasks that are difficult. Yes No Your State/Region * Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) District of Columbia (DC) Delaware (DE) Florida (FL) Georgia (GA) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) American Samoa (AS) Guam (GU) Northern Mariana Islands (MP) Puerto Rico (PR) US Minor Outlying Islands (UM) Virgin Islands (VI) City * Postal Code * Please describe the study you are interested in learning more about (type "general" if you are not looking for a specific study). * Are you a parent or guardian of a child/children under 18? * Yes No What is the date of birth of your child/children? Do your children have any of the following conditions (select all that apply)? Acid Reflux Acne Acute Myeloid Leukemia ADHD Allergies Anemia Anxiety Asthma Atopic Dermatitis Autism Autoimmune conditions Bipolar Bleeding Disorder Celiac Cancer Cerebral Palsy Colitis Conditions that cause Seizures Crohn's Disease Diabetes (Type 1) Diabetes (Type 2) Ehlers-Danlos Syndrome Eczema Eosinophilic Duodenitis (EoD) Eosinophilic Esophagitis (EoE) Eosinophilic Gastritis (EoG) Epilepsy Gastrointestinal conditions Hemophilia A/B IBD IBS Intestinal conditions Juvenile Arthritis Lyme Disease Migraines Obesity Psoriasis Seasonal Allergies Seizures Ulcerative Colitis Other None Have you ever or are you currently serving in the military? * Yes No Have you ever lied or misled someone in order to participate in paid research? 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