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Permission Request Form

MDS Clinical Outcome Assessments / Rating Scales

Permission is required for each single use

All MDS Rating Scales are copyrighted materials owned and managed by MDS. All individuals and organizations looking to use these materials must agree to the terms of use, and obtain express written permission from MDS prior to using the Rating Scales. Proper authorization maintains the integrity of these validated assessments.

Important Usage Guidelines:

Unauthorized use violates copyright law.
Each use (per scale, study protocol, or language) requires separate permission.
A licensing agreement may be required and licensing fees may apply.
Review the pricing chart for applicable fees.
A standard license only covers scale administration in paper format.
Modification, translation, or electronic development is prohibited without express prior approval, and must be indicated in your request.
If modification, translation, or electronic development is intended, please indicate this in your request.
Approval must be obtained before any modification, translation, or electronic development can begin.

Fields marked with an asterisk (*) are required. For any questions please contact ratingscales@movementdisorders.org.

Prefix:*

First Name:*

Last Name:*

Company/Organization:*

Department/School/Division:

Street Address:*

City:*

State/Province:

Zip/Postal Code:*

Country:*

Telephone Number:*

Email Address:*

Category of use (select one):

Research Study or Clinical Trial

Industry sponsored or commercial

Government, non-profit, or academic

Investigator-initiated

Student-led

Electronic Medical Record (EMR) Integration

Healthcare providers or healthcare systems incorporating the scales into EMR platforms for patient assessment, diagnosis, or monitoring in clinical settings.
No research use, commercial application, or product development

Routine Patient Care

Healthcare providers or healthcare systems using the scales in paper format for patient assessment, diagnosis, or monitoring in clinical settings.
No research use, commercial application, or product development
Paper format only. No modification permitted.

Other

If you are unsure, complete a general permission request form.