PROMs request form

Are you interested in using one of our copyrighted PROMs? Please complete this form and we will follow-up by email.

Title

Name

Email address

Telephone number

Proposed use for PROM:

Title of your study

Is ethical approval required for your study?

Yes
No

Is Ethical approval in place?

Yes
No

If Yes, please provide ethics application reference

Your Enquiry

Details of your enquiry

Which PROM do you require?:

How will the PROM be administered?

Phone app
Tablet
PC/Web Platform
Paper Copy

Who is the sponsor for your study?

Is funding in place for your study?

If other, please specify

In which language and Country will the PROM be used?

How many patients will you collect the PROM information from?

On how many occasions will you collect the PROM information from each patient?

What is your company/institution name?

What is your company/institution address?

Additional Comments:

Data Protection

By submitting your enquiry you are consenting to your data to be held by Swansea University. Your data will be used for the purposes of dealing with your enquiry, and sending you relevant information about Swansea University. Swansea University will not pass your details on to any third party. If you wish to remove yourself from Swansea University's database please contact Admissions Office, Swansea University, Swansea, SA2 8PP or email study@swansea.ac.uk