2025 UHDRS® & vUHDRS®

Request Form

The Unified Huntington Disease Rating Scale and revised UHDRS® '99 and accompanying manual (collectively, the “UHDRS®”) and vUHDRS® and accompanying manual (collectively, the “vUHDRS®”) are the copyrighted intellectual property of the Huntington Study Group, Ltd. (“HSG”). The UHDRS®, vUHDRS®, case report forms, and other related materials are copyrighted by the HSG. Individuals, organizations, firms, or other entities seeking to use these tools and/or materials must obtain prior written permission from the HSG. License fees will apply.

 
 

REQUESTER INFORMATION

 
 
 
 
 

Please include Street, City, Zip Code, Country

 
 
 
 

Please select if you are a Not-for-Profit or For-Profit organization.

 
 

Are you a member of the HSG? If no, become a member here: https://huntingtonstudygroup.org/membership/

 

Please provide the name, full physical address, and email address of the contact person at your organization who is responsible for legal notices.

 
 

What is your intended use of the UHDRS®? Please describe in detail.

 
 

Which version of the UHDRS® are you requesting to license?


  • If you are administering the UHDRS® in person, please select the UHDRS® only option.


  • If you are in administering the UHDRS® virtually, please select the vUHDRS® only option.


  • If you are administering the UHDRS® both in person and virtually, please select the UHDRS® & vUHDRS® option.
 

Licensee will use the Works in the study / clinic / educational environment in the following manner (select one or more):

 

Please list all languages that you request the UHDRS® for:

 

In what setting will the UHDRS® be administered?

 

Please specify in what setting you will be administering the UHDRS®:

 
 

CLINIC / EDUCATION

Please complete this section if you are requesting a license for clinical or educational use. If this section does not apply to you then please answer N/A to these questions and move to the next section.

 

Total number.

 

Total number.

 

How many years are you planning on assessing your patients for?

 
 

RESEARCH

Please complete this section if you are requesting a license for research or study purposes. If this section does not apply to you then please answer N/A to these questions and move to the next section.

 
 
 
 
 
 
 

Are any industry or commercial sponsors associated with the study?

 
 

Please list all countries the study is being conducted in:

 
 

Total number.

 

Total number.

 
 

What is the expected start date of the study/trial?

 
 
 

ADDITIONAL COMMENTS

 

Any additional information that will be useful in creating a UHDRS® license agreement?