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Healthcare & Wellness
Clinical Trial Volunteer Screening
Pre-screen research volunteers across three short pages — contact details, health background, then availability and consent — before inviting them to a site visit.
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What this form looks like
Preview · not interactiveClinical Trial Volunteer Screening
Pre-screen research volunteers across three short pages — contact details, health background, then availability and consent — before inviting them to a site visit.
About you
Your name*
Email address*
Screening results and visit invitations go here.
Phone number*
Date of birth*
Pick a date📅
Volunteers must be 18 or older.
Sex at birth*
Select…▾
Asked because some study criteria depend on it.
Home address*
Helps us match you to the nearest study site.
Health background
Have you been diagnosed with any of these?
Select…▾
Current medications
Do you smoke or vape?*
No
Occasionally
Daily
Height (cm)
e.g. 172
Weight (kg)
e.g. 70
Availability & consent
When could you attend site visits?*
Select…▾
How far would you travel for visits?*
Select…▾
Recent medical summary (optional)
⬆ Drop a file or click to upload
A discharge letter or recent lab report speeds up screening. PDF or image, up to 10 MB.
Study screening conditions*
Study screening conditions
Contact permission*
Contact permission
Submit