If you would like to learn more about participating in a research study, please email MediSearch Clinical Trials using the form below. We value your privacy and your information will only be used by the research center to contact you regarding this study.

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* 1. Contact Information

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* 2. Date of birth

Date / Time

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* 3. If you are interested in participating in any of these clinical research studies please check the box

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* 4. Do you have any other comments, questions, or concerns?

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* 5. Most these studies involve anywhere from 5-6 study visits over a course of 12 weeks.  Study visits will last anywhere from 45 to 90 minutes.  Will you be able to attend these scheduled study visits?

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* 6. Where did you hear about us?

Thank you for taking this pre-screening survey.  The answers you have provided will be available to MediSearch Clinical Trials staff only and will help us determine if you may be eligible for the study.  Information will not be shared with any other parties.  If you appear to be eligible for the study, someone from MediSearch Clinical Trials will contact you.  If you have any questions, need help completing the pre-screening survey or wish for MediSearch Clinical Trials to remove your contact information from our database, you may contact us at 816-364-1515.

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