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Usability Test - Sign up form

Thank you for your interest in signing up to the Usability Testing of the Samphire Hairband and Mobile App! The information you provide in this form is completely confidential and your data will be pseudonymised, and will not be shared with anyone outside the Samphire Neuroscience team without your consent. If you have any further questions about the process please contact us at justyna@samphireneuro.com

Please enter your full name.

Do you have an iPhone?

Do you have an iPhone?
A
B
Currently the Samphire Mobile Application works only on iOS. If you have an Android or any other phone, we are able to provide selected users with an iPhone for the duration of the usability tests. If at the time being we do not have sufficient iPhones available to accommodate all users, you will be asked to participate in the next round of usability tests.

Please enter your Apple ID email address.

We need this information in order to provide you with access to the Samphire mobile application. (Not applicable if you do not have an iPhone)

How shall we stay in contact with you?

We need this information from you to provide you with the necessary documents and updates. You will not be sent any emails or messages other than the ones necessary for the usability testing.
How shall we stay in contact with you?
A
B
C

Please enter your preferred email address (if applicable)

Please enter your phone number (if applicable)

When are you next expecting to start your menstrual period?

We need this information to ensure you receive the Hairband in time to start the usability testing.