Information form for Pharmaceutical Company Use of the MPFID

Please complete the form below to provide additional information about use of the MPFID for pharmaceutical companies and someone from our team will be in touch soon.

Return to Migraine Physical Function Impact Diary (MPFID)

Name*
First Last
Title / Degree*
Affiliation*
Company Department City State / Province / Region ZIP / Postal Code Country
Email Address*
If ePRO is planned, who will be your ePRO provider?*
Describe phase and type of study*
Describe the purpose of use for the MPFID*
What Language Versions do you require?*
To contact Evidera with your inquiry, please complete the form above. Fields marked with * are required. Pharmaceutical Product Development, LLC and its affiliates including Evidera (together "PPD") will use the information you provide on this page for the purpose of reaching out to you and responding to your inquiry. Important information on how PPD handles personal data and what rights you may have under data privacy laws are included within PPD's Global Privacy Policy.