Request Further Information

Please complete the following form to request further information. These details will be sent to Professor Bellamy who will respond to your request in due course.

Please enter your personal details First name, last name, and email address are required
First Name:
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Please indicate your professional classification Please select all that apply.

Biotechnology Company Contract Research Organisation (CRO) Health Management Organisation (HMO) Library Occupational Therapist Orthopaedic Surgeon Pharmaceutical Company	Physiotherapist Publishing Company Rehabilitation Specialist Rheumatologist Student - Postgraduate Student - Undergraduate Other
Intended Application
Clinical Practice Clinical Research Instrument Development	Education Other
Details of intended application

Protocol number and protocol title
Total number of patients to be studied
Period under study for each patient
Total period of use of index
Number of visits per patient during study period
Source of funding	Commercial/ Industry Peer Review Private - Please specify Unfunded

Details of instrument required
Type:	WOMAC® 3.1 Index	AUSCAN™ 3.1 Index	OGI™ 8.0
Scale:	Likert (5 point)	Visual Analog (100mm)	Numerical Rating Scale (11-point)
User Guide:	WOMAC® Yes No	AUSCAN™ Yes No