PSP Patient Research Panel – Registration Form

Thank you for your interest in joining Physician Survey Panel (PSP) research panel. As a member, you will be invited to participate in surveys and studies that help improve healthcare services and products. Please fill in your details below.

Full Name

Gender

Date of Birth

Country of Residence

City

Contact Number (Enter country code)

Email Address

Alternate Email

Education Level

Occupation

Marital Status

What type of disease you are suffering from?

In which year you were first diagnosed with the disease you selected above?

Frequency of Doctor Visits

Are you open to testing new products or participating in clinical research?

What describes your best availability for research activity

How do you know about PSP?

Consent Form

We value and respect your privacy. The personal and professional information you provide will remain strictly confidential and will be stored securely in compliance with applicable data protection regulations (such as GDPR).

Your data will only be used for the purpose of inviting you to participate in relevant healthcare or consumer research studies. It will never be sold, shared, or disclosed to third parties without your explicit permission, except where legally required.

All responses are aggregated and used only for research and informational purposes, ensuring that no individual is personally identified in the reporting of results.

By proceeding, you acknowledge that you have read and understood this statement and agree to the secure processing of your information for research-related purposes.

I agree to join PSP's consumer panel and consent to being contacted for participation in relevant research studies in accordance with data privacy regulations.