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Application for providers/practice owners

You are requesting a contract. In order to participate and receive survey access codes for your clients, a provider must first sign a contract with Triqs, the analyzing bureau. After you send this form your request will be processed and you will receive an email with the next step. 

The reason Triqs wants you to sign the contract is that they process data arising from the relationship between a client and the practice owner. This data is tied to this particular study and therefore a signed contract is required. 

If you do not receive a reply within 24 hours please check your spam folder for our email. If you can’t find it there either, you can send an email directly to

Thanks for submitting!

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