In this section:

Participating in Research Form

The RNIB Digital Accessibility Team, undertakes projects in conjunction with other organisations with the aim of influencing the design of equipment and systems for the benefit of blind and partially sighted people. Such projects require a sample of people from the blind and partially sighted population to participate in the research because their input is regarded as invaluable.

This form is also available as a plain text Word document (KB).

Please note, the personal information collected on this page will be treated in accordance with our privacy policy. In addition, personal information collected on this page will be made available to third parties with your consent.

Personal Details

Title:
First name:
Surname:

Contact Information

Address:
Post code:
Telephone number:
Fax number:
Email:

Computer Literacy

Are you computer literate? Yes No

Visual Impairment Information

Media

What is your preferred media? Print Large Print Braille Email Audio
Can you read braille? Yes No
Can you read normal print? Yes No
Can you read large print? Yes No

Vision Impairment Details

What is the cause of your sight problem?
How long have you had this?
Do you have residual vision? Yes No
Is it central residual vision? Yes No
Is it peripheral residual vision? Yes No
Can you perceive only light? Yes No
Are you colour blind? Yes No

Devices and Aids

Which low vision devices do you use?
Do you use a cane? Yes No
Do you use a guide dog? Yes No

Additional Impairments

Do you have any additional impairments?

Your Feedback

Do you have any ideas for future research projects?
Any other comments?

Third Party Contact

Do you agree to the above details being passed on to third party researchers? Yes, I agree No, I disagree