If you are interested in participating in one of our clinical studies, the following questions will help us determine which studies you may be eligible for.  This is a secure website and complies with health information privacy laws.  All information collected will be kept confidential and we do not share your contact information with third parties.  The questionnaire will take approximately 10 to 15 minutes to complete.

Questions marked with an asterisk (*) are required.  All other information is optional.  The more information you provide about yourself, allows us to understand which studies may be of most interest to you and which you may be eligible to participate in.   

If you have already completed a study pre-screening questionnaire on our website, there is no need to complete this survey as we already have your information.

If you wish to proceed, click the button below to begin.

When completing the questionnaire, please do not click your browsers back button.
This questionnaire is optional.   Please provide complete and honest answers to the questions to ensure whether this study is a good fit for you or not.  If you wish to proceed, click the button below to begin.
Estimated time to complete:

PART 1: 5-10 minutes

PART 2: 1-20 minutes (optional)

3% of survey complete.