Submit Online Request Form

In order to obtain the scale, please complete and submit the project information form. On the basis of this information we will send an agreement which describes terms of use and payment details. Once this has been completed, the scale and user's manual will be promptly forwarded.

Request for CD-RISC

Name of Principal Investigator/Project Director/Clinician

Department/Organization

Street Address

City, State/Province Zip/Postal Code

Country

Telephone Number

Fax Number

Email

1. Organization Type: Select the category that best describes the type or primary purpose of your organization.

Please Select an Organization Type Medical Group Hospital Academic Center Private Foundation Insurance Company/Health Plan Government Agency Consulting Firm Pharmaceutical Company Other

**If you selected Organization Type "Other", Please Explain:

2. Please briefly describe the project in which you plan to use the CD-RISC:

3. Number of subjects in sample

4. Number of times the CD-RISC will be administered to each subject:

5. Project duration:

Please choose an option Less than 1 year 1 year 2 years 3 years 4 years 5 years More than 5 years

6. Method of assessment (e.g., mail survey, internet):

7. Please indicate if you prefer the RISC-2, RISC-10, RISC-25. Please note: For some translations, we do not have all three versions of the RISC.

Please choose an option RISC-2 RISC-10 RISC-25

8. Please indicate if you are a student:

Please choose an option No Yes

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