Dermatology Quality of Life - Licensing

Licence for For-profit organisation

Use this form to request a licence for the use of the Quality of Life questionnaires by a for-profit company/organisation.

If you are using the questionnaires for a not-for-profit organisation, please return to the start page and select the correct option.

If you wish to use the Cardiff Acne Disability Index (CADI) or Psoriasis Disability Index (PDI), please contact technologytransfer@cardiff.ac.uk

For FROM-16 only, all requests for licensing and for information have to be submitted through the ePROVIDETM platform.

This licence covers the use of any validated translations given on our website. There is no need to specify which translation(s) will be used.

The online form provides an instantaneous licence. The form and the terms and conditions attached to it form the agreement. Once you submit the form you will receive a confirmatory email to state the license has been granted.

In due course we will raise our invoice using the information supplied on the form. If you require us to reference a Purchase Order or other unique number on our invoice then please ensure you include this in the space provided on the form.

If you need any help with licensing, please contact technologytransfer@cardiff.ac.uk. For all other queries e.g. translation, validation or electronic use, contact dermqol@cardiff.ac.uk

Client Title

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Type of use

Please select from this list how you are planning to use the questionnaire, or the type of study and institution you are associated with. If you cannot find a relevant type of use on this form, please contact technologytransfer@cardiff.ac.uk, providing details of how you would like to use the questionnaire.

For all other queries e.g. translation, validation or electronic use, contact dermqol@cardiff.ac.uk.

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Institution / Organisation Name

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CRO name CRO means Contract Research Organisation

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Invoice Details

If the invoice / payment details are different to the details listed above, please enter them here. If not, please leave this section blank.

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Study Number / Reference / Code

Study Title

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Number of participants

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Study start date The licence is valid from when you submit this form

Expected Study End Date Please use the date format DD/MM/YYYY

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Questionnaire type Please note, a separate licence is required for each type of questionnaire.

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Payment Currency

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VAT Number

Purchase Order Option Select

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Purchase Order Number

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Accept Licence terms (Commercial)

I agree to the Terms and conditions of the licence

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Authorisation

I confirm that I have the authority to request a licence on behalf of the institution / organisation that I represent

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Affiliate	means any entity directly or indirectly controlling or controlled by or in common control with such entity;
Data Protection Legislation	for so long as the GDPR applies to the United Kingdom, the European General Data Protection Regulation 2016 ((EU) 2016/679) (the GDPR) and any national implementing laws, regulations and secondary legislation; UK Data Protection and Digital Information Bill (Bill 143 2022-23) and any regulations made pursuant to it; any other laws and regulations relating to the processing of personal data and privacy which apply to a Party; and, if applicable, the guidance and codes of practice issued by any competent data protection supervisory authority;
control	means ownership of at least fifty percent (50%) of an equity or beneficial interests of such entity, or the right to vote for or appoint a majority of the board of directors or other governing body of such entity and the terms ‘controlling’ or ‘controlled’ shall be construed accordingly;
Copyright Statement	the Index must always be reproduced with the appropriate copyright statement at the end of each copy of the Index, or visible to any user of any electronic version. Details of the appropriate copyright statement is available on the Cardiff University, Department of Dermatology website http://www.dermatology.org.uk/and will be sent to the Licensee via e-mail shortly after completion of the online order form by the Licensee ( the “Online Form”);
CRO	means a contract research organization;
Index	means the index/questionnaire subject to this Agreement (specified in the Online Form completed by the Licensee) and any translation from the English version of commissioned or confirmed by the University and available for download from cardiff.ac.uk/medicine/resources /dermatology-questionnaires
Licensee	the organisation named in the Online Form;
Online Form	the on-line application form submitted by the Licensee;
Study	details of which were submitted to UC3 on the Online Form;
Tobacco Company	means: (i) any person who develops, or manufactures tobacco and/or nicotine products; and/ or (ii) any person which makes the majority of its profits from the importation, marketing, sale or disposal of tobacco and/or nicotine products. Furthermore, Tobacco Party shall include any person that is controlled by or under common control with any of the persons referred to in (i) and/or (ii).
UC3	University College Cardiff Consultants (company number 01477909) whose registered office is at 30-36 Newport Road, Cardiff CF24 0DE
University	Cardiff University with administrative offices at 30-36 Newport Road, Cardiff, CF24 0DE, UK, established under royal charter, registered charity number 1136855

Index	Initials of Index	Reference Number
Dermatology Life Quality Index	DLQI	MyIP 2007015
Children's Dermatology Life Quality Index	CDLQI	MyIP 2014061
Children's Dermatology Life Quality Index (Cartoon Version)	CDLQI	MyIP 2019011
Family Dermatology Life Quality Index	FDLQI	MyIP 2015017
Dermatitis Family Impact Questionnaire	DFI	MyIP 2015008
Infant's Dermatitis Quality of Life Index	IDQOL	MyIP 2015028
Teenagers’ Quality of Life	T-Qol	MyIP 2019012
Psoriasis Family Index	PFI-14	MyIP 2018078
Major Life Changing Decision Profile	MLCDP	MyIP 2019053