The Migraine Patient Organisation would appreciate a moment of your time. If you are interested in being a contributor to market research being conducted regarding the treatment of migraines in South Africa, please complete the following four short questions. The confidentiality of your response will be respected. Your email address will not be known to anyone other than the Drug Information Centre gathering the information.

I would like to contribute      I'm not interested at this time

1) Where did you get this website address?		IOL Health24 Discovery Body & Soul Shape magazine (website) Shape magazine (print)
2) Are you: Male Female
3) How old are you? Younger than 24 years 24-35 years Older than 35 years
4) Do you suffer from headaches/migraines? Yes No
5) Can we send you some additional market research questions in the future? (Not promotional material) Yes No
Your Email Address

The personal information that you are sending, including your e-mail address, will not be disclosed to any third party. The confidentiality of your responses will be strictly maintained by the independent company collecting the information for market research purposes. Please click on send to send your response now.