Phoenix Research Center Study Interest Form

Thank you for your interest in participating on our paid studies to test beauty and consumer products.  By completing all of the questions, it will help us determine which studies you may qualify for.

Each study requires different qualification criteria and for a majority of our studies we require the following eligibility. If you do not meet these, please do not complete the survey.
Inclusion:
1. In general good health (physical, mental, and social well-being, not merely the absence of disease/infirmity)
2. Individual giving informed consent must be able to read, speak, write, and understand English.
Exclusion:
1.  History of skin cancer within the past 5 years.
2. Having a history of immunosuppression/immune deficiency disorders (including HIV infection or AIDS) or currently using immunosuppressive medications (eg, azathioprine, belimumab, cyclophosphamide, Enbrel, Imuran, Humira, mycophenolate mofetil, methotrexate, prednisone, Remicade, Stelara.) and/or undergoing radiation.
3. Having an uncontrolled disease such as asthma, diabetes, hypertension, hyperthyroidism, or hypothyroidism. If you have multiple health conditions, you may be excluded from participation even if the conditions are controlled by diet, medication, etc.
4. Current participation on another study.

Please note:
*All information you provide will be kept confidential
*You may be contacted by telephone
*Your information may be added to a database
1.First Name(Required.)
2.Last Name(Required.)
3.Email Address(Required.)
4.Phone Number(Required.)
5.Date of Birth(Required.)
Date / Time
6.Which clinic is closest to you? If you live in Texas, please do not complete this survey.  To participate  in a study at our Texas location, visit www.sastudies.com, email us at recruiting@stephens-associates.com or call 1-833-530-7596(Required.)
7.How did you hear about us?(Required.)
8.Who is your group leader?  If you do not have one, please state that you do not have a Group Leader.(Required.)
9.Do you have any of the following skin conditions(Required.)
20%