Toggle navigation Load unfinished survey Resume later Exit and clear survey default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. H.2215-0822 Heart Attack You are about to fill in a short survey which will help determine your suitability to this research project. Please be aware that all data you provide us with will be held in accordance with the data protection policy outlined on our website. For further information please visit https://www.healthcareopinions.co.uk/privacy-policy/ (This question is mandatory) What is your name, contact number and email address? First Name Surname Contact Number Email Address Postcode (This question is mandatory) Please tell us your age. Only numbers may be entered in this field. Your answer must be between 1 and 99 (This question is mandatory) Are you... Choose one of the following answers Male Female Prefer not to say Other: (This question is mandatory) What is your working status? Choose one of the following answers Please choose... Full time Part Time Non working Retired Housewife/househusband In education Other: Other: (This question is mandatory) If applicable, what is your occupation? (This question is mandatory) Are your details currently registered with us? If you haven't, please do so here http://https://www.healthcareopinions.co.uk/ Choose one of the following answers Yes No (This question is mandatory) Where did you hear about this research participation opportunity? Check all that apply Email directly from Research Opinions Recommended from a friend or family member Healthcare Opinions website Facebook Instagram Other: (This question is mandatory) Are you left or right-handed? Choose one of the following answers Right Left Ambidextrous (This question is mandatory) Have you ever experienced a heart attack? Choose one of the following answers Yes No (This question is mandatory) When did you experience the heart attack(s)? (This question is mandatory) Have you ever been diagnosed with a condition which impacts your memory, ability to learn or cognitive function? Choose one of the following answers Yes No (This question is mandatory) Do you have any difficulties with dexterity in your hands and fingers? For example, do you find it difficult buttoning up a shirt, turning a key in a lock, hold and writing with a pen, or anything else like that? Choose one of the following answers Yes No (This question is mandatory) Do you have any difficulties with your vision? (Including wearing glasses) Check all that apply Yes, I am severely sight impaired and this is not correctable with glasses or lenses Yes, I am sight impaired/ partially sighted and this is not correctable with glasses or lenses Yes, I use glasses or contact lenses to correct my vision No (This question is mandatory) Are you, or is any member of your immediate family, employed by the following? Check all that apply Pharmaceutical company Medical device manufacturer Market research company Medical office, clinic, or hospital None of the above Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×
