Project MOVING HOME (Brain Imaging) 

First Name

Last Name

E-mail Address

Age

Date of Birth

Gender

Ethnic Origin

Occupation Of Head Of Household

Occupation Of Respondent

Address

Post Code

Contact Number

Have you taken part in any Brain Imaging research before?

YesNo

Do you or any members of your household currently work, or have ever worked in any of the following industries/occupations?

Advertising agency or advertising department within a companyMedia/Journalism/PublishingMarket ResearchMarketingPublic RelationsNone of the above

Are you a permanent resident in the UK and have been living in the UK for the last year?

Yes, I am a permanent UK resident and have lived in the UK for the last yearNo, I am not a permanent UK residentI am a UK resident but I have not lived in the UK for at least one year

Do you suffer from...

EpilepsyMigrainesNeither

How often do you suffer from migraines?

Once or twice a weekOnce a monthLess than once a monthNever

What triggers your migraines?

Do you suffer from severe sensitivity to light?
YesNo

Have you had any Brain Surgery or had any type of Brain Injury in the past?
YesNo

This study requires access to your scalp - do you wear wigs, hairpieces, or any other head coverings, or anything that will make access to your scalp difficult?

YesNo

What is your Marital Status?

SingleMarriedCo-habitingWidowedDivorcedSeparated

In order to comply with Government advice on COVID-19 procedures, we need to ask the following questions?
Do you suffer from any of these conditions?
Cardiovascular DiseaseCancerDiabetesChronic Respiratory DiseaseChronic Kidney DiseaseLiver DiseaseMorbid ObesityBrain or Nervous System DisorderNone of these

Are you:
Taking ImmunosuppressantsPregnant or do you live with someone who is pregnantNone of these

Are you familiar with any of these websites?
ZooplaRight MovePurple BricksPrime Location

Which device do you usually use to access these websites?
Access website on PC/Laptop)Access website on my mobile deviceAccess website via the app

How often do you use Rightmove on your mobile device nowadays?
Less than once a month2-4 times a monthA minimum of once a week3+ times a weekMore often
Which of the following applies to you?
I am open to moving if the right property came upI want to, or need to move soonI do not expect to move in the next 12 monthsI am unsure of when I would like to moveI expect to buy a property in my next moveI expect to have bought a property in the next 12 monthsI am buying a home to live in (I am not an investor or landlord)

Will you be
Buying a property onlyBuying and selling a property

Which group are you interested in attending?
Thursday 2nd Sept - 4:00pmFriday 3rd - 09:30pmTuesday 7th Sept - 09:30amTuesday 7th Sept - 1:00pm