Me + My Medicines - Taking part in our research project

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We appreciate you clicking on this link!

Hopefully it means that you are willing to participate in our research project, and we couldn't be more grateful. This form will collect a bit of data about you so that we understand more about who you are and where you're based. This information will be shared with Ayup Digital — the agency contracted by the Association to undertake the research. Your data will not be shared with anyone else outside of Me+My Medicines and Ayup's team, and will be deleted at the end of the project.

This form should take a couple of minutes to complete. Upon completion, you can expect to be contacted by a member of Ayup Digital's team within a couple of days. They will be responsible for screening the information provided and selecting participants that fit the scope.

Email *

Name *

Age *

How would you best describe your ethnicity? *

When was the last time you visited the GP? *

Within the last week

Within the last month

Within the last three months

Within the last six months

Within the last year

More than a year ago

Other:

Do you take any medication regularly? *

Yes

Other:

In which city do you live in? *

Had you ever heard about Me + My Medicines before? *

Yes

Other:

What might you be able to help with? *

You can select more than one option. This doesn't commit you to take part at this stage but helps us to gauge interest. You can change this at a later date.

Interview (45 minute session done over video-chat or phone) - £10 voucher incentive

Focus group (2h30 - 3h meeting in Leeds city centre) - £15 voucher incentive + up to £10 for travel costs

Required

Your consent *

I consent voluntarily for Yorkshire and Humber Academic Science Health Network and Ayup Digital to store and process the data I have provided above in order for them to make contact with me in regards to their research project. I understand I can opt-out at any time and that this data will be deleted at the end of the project. If I choose to opt-out, I understand my data will be deleted immediately.

Required

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