Instrument Use Agreement Fields marked with an * are required First Name * Last Name * Email * Degrees Title Institution City * Country * - Select Country - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire Croatia (Local Name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia, South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre And Miquelon Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic Of Thailand Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe What instrument do you want to use? * SC Self-Efficacy Scale SC of Heart Failure Index SC of Hypertension Inventory SC of Diabetes Inventory SC of Coronary Heart Disease Inventory SC of Chronic Illness Inventory SC of Chronic Obstructive Pulmonary Disease SC Inventory Caregiver Self-Efficacy Scale CC-SC of Heart Failure Index CC-SC of Diabetes Inventory CC-SC of Coronary Heart Disease Inventory CC-SC of Chronic Illness Inventory CC-SC of Chronic Obstructive Pulmonary Disease What is the language of the instrument you want to use? * Is the instrument available in that language? * Yes No How will you be using this instrument? * Clinical Practice Student Project Research Grant Other Please provide more details (add 2-3 lines): * Contact HTML You must agree to these terms and conditions if you want to use this instrument. Do you agree…? Not to change the instrument in anyway without explicit permission of the author * Yes No To calculate scores in the manner prescribed on the website * Yes No To properly cite the instrument in all publications using it, referring to the original publication * Yes No Not to include the instrument itself in any publication because that transfers the copyright to the journal publisher * Yes No By typing your full name below you agree to this use agreement. * Recaptcha Must Agree Label YOU DO NOT HAVE PERMISSION TO USE THIS INSTRUMENT. You must agree to all the terms and conditions. Author Email Author Name Author Line 1 Author Line 2 If you are a human seeing this field, please leave it empty.
