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Patient Involvement Network Questionnaire
1.
Contact Information
Name
Address
Address 2
City/Town
Post Code
Email Address
Phone Number
2.
Are you happy to share with us any pre-existing or current disease areas you have been a patient of or participated in a research study within our department?
You do not have to have been a patient or participated in a study to be interested in a research area
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Allergy
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Audiology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Cancer
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Cardiology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Clinical Genetics
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Dental
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Dermatology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Diabetes
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Ear, Nose & Throat
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Emergencies & Critical Care
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Gastroenterology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Haematology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Hepatology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
HIV
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Infection
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Lupus
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Men's Health
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Neurology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
None
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Nutrition & Dietetics
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Ophthalmology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Orthopaedics
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Paediatrics
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Pain
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Palliative Care
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Renal
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Respiratory
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Rheumatology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Sexual & Reproductive Health
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Sleep
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Surgery
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Urology
Been a patient of
Participated in a Research Trial
Interested in getting involved in this area
Others not mentioned
3.
Which of the following Research Areas would you be interested in becoming more involved in if any?
Please tick all that apply
Genomics / Genetics
Please tick all that apply
Data research & Artificial Intelligence (AI)
Please tick all that apply
Cell / Gene therapy
Please tick all that apply
Social science
Please tick all that apply
Stem cells
Please tick all that apply
Imaging e.g. x-rays, CT, MRI
Please tick all that apply
4.
Any Comments / Suggestions/ Feedback:
