Registrationform

EQ5D-registrationform
Registration Form

EQ-5D Registration Form Fast Track No license agreement needed. We aim to deliver EQ-5D within 5 business days after you have agreed to the Terms of Use. Standard A license agreement is needed. EQ-5D can be only delivered once an agreement has been set up, negotiated and signed. Within 10 business days a representative from the EuroQol Office will be in contact. Priority Commercial registration. Priority Route selected. Response time for commercial requests is 5 business days.

Dear visitor,

The EQ-5D Registration Form is currently down for maintenance, please try again later.

Apologies for the inconvenience caused.

Best regards,
The EuroQol Research Foundation

The EuroQol Research Foundation is a registered charity in the Netherlands and serves as the single point of distribution of the family of EQ-5D instruments.

Commercial requests to use the EQ-5D, made by or on behalf of a pharmaceutical company, medical device manufacturer or any other for-profit stakeholder, are subject to our commercial license fee structure (see the User License Policy). Consultancies / CROs are required to disclose the name of the sponsor during or after the registration in order to check available active license agreements. Commercial requests will be handled with priority. Depending on whether there is an active license agreement in place, a quote, a license agreement and/or a third party agreement will be drafted. The response time for commercial requests is 5 business days.

Non-commercial requests to use the EQ-5D, will be processed without charging a license fee. In most cases you only need to agree to our Terms of Use in order to obtain EQ-5D. In some cases a license agreement, a third party agreement and/or a digital cost recovery fee may be required (see the User License Policy).

Please indicate below if you are registering a commercial- or a non-commercial study/project:



The EuroQol Research Foundation’s legal department will review your registration and will determine the applicable policy.

Next

Process

You have indicated that you are registering a non-commercial study/project, or that you are not sure about the status of your study/project. You are now on the Non-commercial track. You can use the "Back" button below to change your track.

For non-commercial requests that do not require a license agreement we have Fast Track, marked in green in the diagram below. For Fast Track requests, we aim to deliver EQ-5D within 5 business days after you have agreed to our Terms of Use.

As you can see in the orange page title bar above, the Fast Track indicator is now on. However, based on your entries on the next screens it may turn off. This means that a license agreement will be needed. Furthermore, in some cases a screenshot review fee will be charged (see the User License Policy). EQ-5D can only be delivered once an agreement has been set up, negotiated and signed. The response time for non-commercial requests that need a license agreement is 10 business days.

Back

Your details

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Work environment*
Please specify other work environment*
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Please enter the name of your organization / institute / hospital / university
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Intended use of EQ-5D

Title / Description / Study Code*
Objective*
Source of funding / Sponsor*
Please list CROs if applicable
Please list Vendors if applicable
EQ-5D will be used for*
Please specify other intended use*
Study design / primary use*
Please specify other design / primary use *
Clinical area*
Other clinical area*
Number of patients / respondents for this registration*
Start date (year only) *
End date (year only) *

Requested EQ-5D versions

First, please select the countries/regions and the languages you need from the ‘available versions’ picklist below. When a country/region + language is not in the list, please fill it in manually in the Other Country/region and Language. Then, select the mode(s) of administration.

  • Before you register your study, please think carefully which EQ-5D version (3L, 5L or Y) and which mode of administration (paper, electronic etc.) you need.
  • Please select only what you really need.
  • You may request more than one EQ-5D version, if your research question requires this.
  • If you request more than 1 mode of administration you will be questioned on this. It will take more time to process your request and It may involve (extra) costs.
  • In many cases it is most efficient and cheapest if you collect EQ-5D data on paper.
  • Note that you will need to obtain a REDCap license from REDCap and install the REDCap software on a webserver before you can collect data.
  • If you want to collect EQ-5D data electronically, please consider using REDCap. With REDCap you can collect data on telephones, tablets and laptop/ desktop computers. EQ-5D for REDCap is provided at no extra cost.
  • If you or your vendor wants to use EQ-5D on a PDA/smartphone, Tablet or Laptop/ Desktop computers a cost-recovery fee will be charged of €600 per mode of administration to compensate for the resources needed to draft a license agreement and review the screen shots.
  • If you have any questions on the above information please contact the EuroQol Office.

You have selected a mode of administration for your study for which we charge a setup fee. Please note the following:

  • In many cases it is most efficient and cheapest if you collect EQ-5D data on paper.
  • If you are going to conduct a non-commercial study, you may use EQ-5D on paper for free.
  • If you want to collect EQ-5D data electronically in a non-commercial study, please consider using REDCap. With REDCap you can collect data on telephones, tablets and laptop/ desktop computers. EQ-5D for REDCap is provided at no extra cost. Note that you will need to obtain a REDCap license from REDCap and install the REDCap software on a webserver before you can collect data.
  • If you or your vendor wants to use EQ-5D on a PDA/smartphone, Tablet or Laptop/ Desktop computers a cost-recovery fee will be charged of €600 per mode of administration to compensate for the resources needed to draft a license agreement and review the screen shots.

Available countries/regions + languages
*
Available versions
Your selection
You can find available versions in the list, or by using the search field. You can select a version by clicking on it in the Available versions list. You can deselect it by clicking it in the Your selection list.
Country/regionLanguage
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Please be informed that producing a translation of an unavailable version can take up to 6 months. The translation costs, which usually vary between 1.000-10.000 Euros per requested version, will be invoiced to you. Please click here for more details.

Once you have completed the registration, our VMC Project Management team will be in touch to provide you with more detailed information about the feasibility, timelines and translation costs based on the information provided in the registration form.
Please enter the name of the country/region and language if these are not available in the list above.

Available modes of administration If you want to use a digital version of EQ-5D for which we do not have modular versions available, a screenshot review fee will be charged of €600. Please contact the EuroQol Office if you do not have a budget for the screenshot review fee.
Select EQ-5D versions + Modes of administration for the registration.*
Read more about our Modes of Administration here

Modes of administration that qualify for Fast Track are marked: F
Available modes of administration
Your selection
You can find available modes of administration (MOA) in the list, or by using the search field. You can select a MOA by clicking on it in the Available modes of administration list. You can deselect it by clicking on it in the Your selection list.
➕

Please be informed that producing a translation of an unavailable version can take up to 6 months. The translation costs, which usually vary between 1.000-10.000 Euros per requested version, will be invoiced to you. Please click here for more details.

Once you have completed the registration, our VMC Project Management team will be in touch to provide you with more detailed information about the feasibility, timelines and translation costs based on the information provided in the registration form.
Please enter Mode of Administration if it's not available in the list above.

Available EQ-5D versions

Below you find the EQ-5D versions you selected. Available versions are shown in green. Unavailable versions are shown in grey.
Please review the table and select the versions you require. Note that unavailable versions can be produced for you. However, this will take time and a translation fee will be charged. Please click here for details.

Please be informed that producing a translation of an unavailable version can take up to 6 months. The translation costs, which usually vary between 1.000-10.000 Euros per requested version, will be invoiced to you. Please click here for more details.

Once you have completed the registration, our VMC Project Management team will be in touch to provide you with more detailed information about the feasibility, timelines and translation costs based on the information provided in the registration form.


Selected EQ-5D versions: *
Unavailable versions
Available versions
Language / MoA

Permissions

Are you planning to modify EQ-5D? * Yes
No
Please note that without the prior written consent of the EuroQol Office, you are not entitled to use, reproduce, alter, amend, convert, translate, publish or make available in whatever way (digital, hard-copy etc) the EQ-5D and related proprietary materials.

Please note that EuroQol Research Foundation does not recommend modifying EQ-5D, as by changing the instructions of EQ-5D results in an instrument which deviates significantly from the original version. This could lead to difficulties with authorities if they request EQ-5D data, as the version which is modified might produce different data.

EuroQol Research Foundation would not be responsible and not liable for any issues with the use of the data.
Please specify which EQ-5D modification you plan to do.*
After anonymization, can we use the information you provided in EuroQol reports on EQ-5D usage? * Yes
No
Can we contact you by email in case of important product notifications? Note that you can always opt-out/ ask to be removed from the mailing list. Yes
No
I agree with the Terms of Use and Privacy statement*
Please contact the EuroQol Office if you have any questions or concerns with regard to the Terms of Use and/or Privacy statement.

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