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Clinical Trials Center Volunteer Notification Services

The Clinical Trials Center offers two ways that you can be notified of upcoming clinical trials. You can use our Volunteer Notification Service to receive an e-mail note from us whenever a new clinical trial in your area of interest is added to our listings. Another way you can volunteer for a clinical study is to complete a short questionnaire about yourself. Based on the information you provide in our Trial Volunteer Questionnaire, the Clinical Trials Center will contact you for their upcoming studies.

Volunteer Notification Service

If you are a patient seeking information about clinical trials and would like to be notified by e-mail of future postings to this site in a particular therapeutic area, please sign up here. This service is designed to protect patient confidentiality.

Please note that many people sign up for this service, including patients, friends, family members, health professionals, and members of patient support groups. Your signing on to our Patient Notification Service indicates only your interest in receiving information about clinical trials in the therapeutic area(s) you specify.

You may also choose to use this service to be notified about drugs that have been recently approved by the FDA in a particular therapeutic area.

Please fill out the form below and click on Sign Up to register. To "unregister" from this service, please read the "How To Unsubscribe" instructions at the bottom of this form.

Thank you!

Email address:
Therapeutic areas:

Please select at least one and up to eight therapeutic areas of interest from this list. You may use the SHIFT, CTRL, or other appropriate key combinations to select multiple illness areas.

Please note that if you plan to add illness areas at any time in the future, make sure to re-enter all selections of interest -- your previously selected illness areas will be replaced with your most up-to-date selections.

(You may enter any thereapeutic area(s) that you could not find in the above list in the space provided below.)
Other Interests:
What geographic region are you interested in?
(Give state or region of country. Or, if outside U.S., give name of country.)
Would you also like to be notified about drugs that have been recently approved
by the FDA in the therapeutic area(s) listed above?Yes No

Additional optional information:
Name:
Address:
City:
State:
Zip:

How To Unsubscribe:
Note: You may remove your email address from this service at any time. Simply enter your email address at the top of this form, check "Unsubscribe" below, and click on the "Sign Up" button.
Add/Keep My Subscription Unsubscribe




Trial Volunteer Questionnaire

This is an exciting new service now offered by the Clinical Trials Center. Complete our brief Trial Volunteer Questionnaire. Based on the information you provide, the Clinical Trials Center will contact you by e-mail or telephone for their upcoming clinical trials. It's important for you to know that the information you provide on this questionnaire is not confidential because the Clinical Trials Center will need to review it to determine whether you match its clinical trials.


The following questionnaire is designed to match you or a family member or friend with a clinical trial. By completing this questionnaire and registering for this service, you indicate that you wish to be contacted by the Clinical Trials Center to be considered as a volunteer for its upcoming and ongoing clinical trials.

Once you complete and submit this brief questionnaire, the Clinical Trials Center will contact you by phone or by e-mail.

It's important for you to know that the information you provide on this questionnaire is not confidential because the Clinical Trials Center will need to review it to determine whether you match their clinical trials. By completing this questionnaire, you are authorizing the Clinical Trials Center to release the information you've provided to various research organizations.

Are you interested in participating in a clinical trial yourself or are you looking for a clinical trial for a family member or friend?
I am interested in participating myself
I am seeking a clinical study for a family member or friend

Please fill out the form below and click on Register. Note that you must complete all questions in order to register. To remove your name from this service, please follow these instructions for how to unsubscribe.

Thank you!

Please provide the following information only if you are filling out this questionnaire on behalf of a friend or family member.

Your name (F/M/L):
Your email address:
Your phone number:

Health Profile on Person Interested in Participating in a Clinical Trial

Are you willing to participate in a medical research program?
Yes
No

Please provide the following contact information:

Name (F/M/L):
Email address:
Phone Number:
Address:
Address:
City
State:
Zip code:

Please tell us about yourself or the family member or friend interested in participating in a clinical trial.

Have you ever participated in a clinical trial, and if yes, when was the most recent?
No, I have never participated in a clinical trial
Yes, within the past year
Yes, within the past 5 years
Yes, over 5 years ago

What is your birth date? / /

What is your gender?
Male
Female

What is your ethnic background?

How would you characterize your health?
excellent
good
fair
poor

Do you regularly visit a doctor for health problems?
yes
no

Do you suffer from or have you been diagnosed with any illnesses or conditions?
yes
no

If you answered yes above, please tell us about the medical condition(s) you have by selecting from the diseases listed below. You may select up to ten diseases, To select more than one, hold down the SHIFT, CTRL, or other appropriate keys while you highlight multiple illnesses.

(Note: If you did not see your illness or illnesses listed above, please enter them below, and we will look into adding them to the list.)

Additional
illness
areas:

Do you currently take any of the following types of medications:

Antibiotics Regularly Occasionally Rarely Never
Antihistamines Regularly Occasionally Rarely Never
Pain Relievers > Regularly Occasionally Rarely Never
Heartburn medications Regularly Occasionally Rarely Never
Ulcer medications Regularly Occasionally Rarely Never
Cholesterol lowering drugs Regularly Occasionally Rarely Never
Drugs for high blood pressure Regularly Occasionally Rarely Never
Thyroid medications Regularly Occasionally Rarely Never
Insulin Regularly Occasionally Rarely Never
Steroids Regularly Occasionally Rarely Never
Anti viral medicines Regularly Occasionally Rarely Never

Are you a smoker?
yes
no

Do you drink alcoholic beverages (spirits, wine, or beer), and if yes, approximately how many do you consume in an average day?
I do not drink
Less than 1 per day
1 to 2 per day
Over 2 per day