DIGIHEALTH

Patient sign up form

First Name:
Last Name:
Age:

Gender:

Male Female Other
Ethnicity:

Email address:
Location (Town/County):

Do you have a chronic illness, health condition, skin ailment, disease or disorder?

Yes No
If Yes, what is your chronic illness, health condition, skin ailment, disease or disorder? *This will, help us send you relevant opportunities in the future.
Quick search...

If No, do you care for someone who has a chronic illness, health condition, skin ailment, disease or disorder?
Yes No
If Yes, what is their chronic illness, health condition, skin ailment, disease or disorder?
Quick search...

Would you consider participating in any of the following to discuss your healthcare insights?
Social Listening DigiZings – Single Question Questionnaire Telephone Interviews Focus groups Workshops

Would you consider participating in a clinical study/trial?
Yes No Maybe

How did you hear about the digihealth.club?
Search engine Facebook advertisement A post from a friend on social media Healthcare professional Word of mouth Other

join today