My Health Indicators App pilot study registration form
Thank you for registering to join the My Health Indicators App (MHIA) pilot study.
The research team will use this contact information to fully brief you about the study.
Email address *
Your name *
Your answer
Your best contact number *
Direct phone number preferred including area code if a landline. This number will not be shared.
Your answer
Best time of day to call you *
Your postcode *
Your answer
Your role *
Required
What kind of organisation do you work in? *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of My Health Indicators. Report Abuse - Terms of Service