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NeuroTrials Research 5-minute Prequalification Survey

Page One

Thank you for your interest in participating in a clinical trial with NeuroTrials. Please complete our 5-minute Preqaulification Survey in order to enter or update your profile in our database of prospective participants.

CONFIDENTIALITY STATEMENT

Please note: NeuroTrials Research, Inc. will not sell or give your information to any 3rd parties. Our database is completely confidential. The information collected in this survey is strictly used to assess your potential match for a current or future clinical trial that may meet your interests. If requested, we will remove your information from our database at any time.

To continue, please type what you see in the box. If you are having trouble entering the security code, please call 404-851-9934 to speak with one of our clinical phone screeners, or email us at kmcnulty@neurotrials.com.