Research application
- Are you aged over 13-15?
- Do you use health services?

***You will be given £40 cash if you take part in this research***

To take part, you must be available in central Leeds on Tuesday 12th March 2019.
Sessions will last 60 minutes and take place at either 4:45pm OR 6:00pm.
Research sessions will involve looking at some websites or apps and telling us what you think.

A parent or guardian must attend the session as well, and they will also get £20 cash as a thank you!

PLEASE NOTE: We recommend completing this particular form on laptop or desktop PC if possible, to avoid it jumping around. Once you have submitted your answers, scroll up to see the confirmation message (sorry for any inconvenience).

All information shared with us is protected by General Data Protection Regulation and will not be shared with any third parties. We are compliant with all Market Research Society standards, so the information you provide will only be used to assess your suitability to take part. It will not be used to contact you for marketing or sales purposes at a later date.
About you...
Full name: *
Please provide your first name and surname.
Your answer
Email address: *
If you're selected, we'll send your invitation via email, so please make sure your email address is one that you use regularly.
Your answer
Mobile phone number: *
Please enter the mobile number of the PARENT or GUARDIAN of the child. Please double-check you have typed the correct number, as we'll call you if you're shortlisted.
Your answer
Your age: *
Your answer
Your gender: *
Your child's full name: *
Your answer
Your child's age: *
Your answer
Your child's gender: *
Healthcare...
How do you access health services? *
Please tick all that apply to you
When did you last use an NHS healthcare service? *
Which NHS services have you used within the last 12 months? *
Please tick all that apply to you.
Required
Your availability...
TUES 12th March: I am available for the following sessions: *
Please select 'all day', 'not available', or individual sessions if you are only free for part of the day. Please note if you are flexible, it's more likely that we can invite you to take part.
Required
How did you find out about this research? *
Please provide details such as received email, Google search, Facebook page, Facebook advert, flyer, word-of-mouth etc.
Your answer
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