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.
- Questions
- 19
- Style
- One question at a time
- Price
- Free
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.
About you
Your name*
Email address*
Screening results and visit invitations go here.
Phone number*
Date of birth*
Volunteers must be 18 or older.
Sex at birth*
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?
Current medications
Do you smoke or vape?*
Height (cm)
Weight (kg)
Availability & consent
When could you attend site visits?*
How far would you travel for visits?*
Recent medical summary (optional)
A discharge letter or recent lab report speeds up screening. PDF or image, up to 10 MB.
More Healthcare & Wellness templates
Full name*
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Let patients request an appointment with type, preferred slot, and the reason for the visit.
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Date of birth*
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Option oneOption twoTell us the condition
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A structured history — conditions, medications, surgeries, family history, and lifestyle.
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DataBoard templates
Start from a good first draft.
Pick the closest template, use it, and publish your own version, changed to fit.