EQ5D-registrationform

EQ-5D Registration Form

Please complete this form if you are interested in using EQ-5D. Note that you are not obliged to purchase by registering. If you encounter any problems while using the registration form, please make sure that you have an up-to-date version of your web browser. Alternatively, you can try to register using another web browser. Please complete this form on a desktop computer, a laptop or a tablet. If you require assistance with the registration form, please contact the EuroQol Office

Registration Form

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 / 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 and the languages you need. Then, select the mode(s) of administration.

Available countries + languages

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Available versions
Your selection
You can find available versions in the list and you can narrow down the results in the list by using the search field. You can select a version by clicking on it in the "Available versions" list. You can deselect a version by clicking it in the Your selection list.
CountryLanguage
Please be informed that a full translation can take up to 6 months, for details click here. Based on the inserted information, our VMC Project Management team will be in touch to provide you with more detailed information about the feasibility, timelines and translation costs.
Please enter country name / language if it's not available in the list above.

Available modes of administration

Select EQ-5D versions + Modes of administration for the registration.*
Read more about our Modes of Administration here
Available modes of administration
Your selection
You can find available modes of administration (MOA) in the list and you can narrow down the results in the list by using the search field. You can select a MOA by clicking on it in the "Available modes of administration" list. You can deselect a MOA by clicking on it in the Your selection list.
Please be informed that a full translation can take up to 6 months, for details click here. Based on the inserted information, our VMC Project Management team will be able to provide you with more detailed information about the feasibility, timelines and translation costs.
Please enter Mode of Administration if it's not available in the list above.

Available EQ-5D versions

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

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 specify which EQ-5D modification you plan to do.*
Are you prepared to have this information published in EuroQol reports regarding usage of EQ-5D? Note that only anonymized information will be published. * 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.

Summary

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