You are applying for Study Number 853: UK Wide : Females Non Smokers aged 18 - 45 years of age

By completing the eligibility test below your application will be forwarded for consideration You are under no obligation to subscribe for this study unless you see the benefits of our comprehensive and professional services.

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BIOTRAX - THE ONE STOP SHOP.
 
Test Your Eligibility
Please complete the form below and submit:

Please Note

Do not fill in this form if you are not interested in Clinical Trials or Non Invasive Research.
For Mystery Shopping Services CLICK HERE for our study site.


Many Mystery Shoppers may like to participate in Non Invasive Research In which case it will be an advantage to fill in this test. Click Here click here for a brief explanation.
Country:
First Name:
Middle:
Last Name:
First Line of Address:
Second Line of Address:
City:
County/State:
Postcode/Zip:
Date of Birth:
Day
Month
Year
You must be over 18yrs of age.
/   /  
Guardian Name(if under 18)
Race:      
Sex:      
Phone No:
Mobile No:
Email:
Please Note
E-mail addresses are important if you wish to receive information regarding medical research
         
1. Do you have Asthma?
Yes:
Stroke?
Yes:
Mild Eczema?
Yes:
Glaucoma?
Yes:
Mild Psoriasis?
Yes:
Hepatitis/Liver problems?
Yes:
Seasonal Hayfever?
Yes:
HIV?
Yes:
Diabetes?
Yes:
COPD/Chronic Bronchitis?
Yes:
Heart Disease/Angina?
Yes:
Neurological problems?
Yes:
Osteo-Arthritis?
Yes:
Stomach Ulcer?
Yes:
Rheumatoid Arthritis?
Yes:
Coeliac Disease?
Yes:
Thyroid Problems?
Yes:
Colitis?
Yes:
Epilepsy?
Yes:
Irritable Bowel Syndrome?
Yes:
Depression/Attempted Suicide?
Yes:
Renal Problems (eg: kidney)?
Yes:
  
2. How do you rate your Blood Pressure ?
3. Please check your BMI value using the calculator supplied.  
  Height Ft   In  Weight St Lb 
  
4. With the exception of
Mild Eczema, Mild Psoriasis , Seasonal Hayfever, or Allergies to Anti Biotics, Do you suffer from any Medical Conditions?
(If yes please specify)

Yes: No:
5. Have you ever suffered from any serious illness ?
including clinical depression/ heart problems or murmurs / Hepatitis / Bee Sting Allergies ? (if yes please specify)


Yes: No:
6. With the exception of
any contraception and HRT for women, Do you take any regular prescribed medication? (If yes please specify)

Yes: No:
7. Smoking Status. * For Medical Trials it is better to be under 10 cigarettes per day in the UK although this will not necessarily effect NON Invasive research. In the USA BioTrax does not except smokers for medical trials unless stated on the study site that they are looking for smokers. Again this does not nessesarily effect Plasma Donation or NON Invasive research activties.

Please Note :
Non Invasive / Systemic means no medications are absorbed I.E. Pen and Paper Tests, Psychology Studies, Plasma Donation etc. Wth the exeception of Plasma Donation most of these activities are short visits with hourly rates.
  
8. Do you drink Alcohol? (If so, please specify how many units per week) *A Unit is half a pint, or a glass of wine. 1 Standard pub measure of spirits Bottles (Budwieser/Breezers etc) count as 1 and 1/2 units.

Yes: No:
  Please Note
For females it is better to be under 14 units a week & for males it is better to be under 21 units a week.
9a. Have you taken any recreation drugs in the last 28 days?

Yes: No:
 
Please Note
you are required to abstain from social drugs for a minimum period of 28 days prior to participation in medical trials. Clinics will perform medical tests to confirm this.

9b. What's is Your Recreational Drug Status ?
Please Note
Past Substance Abuse would include addictive use of heroin, cocaine, ecstasy, speed, marihuana etc., but certainly not occasional or infrequent use . There are studies available for Past Substance Abusers and people Not Willing To Abstain , depending on the availability of such studies in your geographical area of participation and will be listed in both patient and healthy volunteer sections when available.

10. Dietary requirements : Most research involving a medication will not except people with dietary requirements . This however does not apply to majority of Non Systemic research or Non Invasive research . If you have requirements and are willing to eat meat/ dairy products for the purpose of the study involving medications , please select 'Willing to eat Meat/Dairy' otherwise choose your dietary requirement.

11. (UK citizen Volunteers)Are you registered with a GP in this country? You will need 3 months min doctors registration in London , Scotland and Ireland and anything from 6 months to 12 months outside of these areas unless the studies are non invasive or non systemic research activities where no medications are absorbed.

USA Residents
Will not require any doctors registration.


Yes: No:
Please Note
If you are visiting the UK, London, Ireland and Scotland are the only areas in the UK where you can use your overseas doctors registration details. You will require their name and fax number, and to be on the safe side, at least 6 months registration with your doctor in your home country. Your doctor will have to be willing to answer faxed information in english, for which doctors are paid for their time and inconvenience.

12. Child Bearing Status ( Female only )

 
13. What geographical radius are you willing to travel for research activity? *Please note some studies involving in house stays are worth travelling to, unless they have a lot of outpatient visits. The greater your travelling distance will increase your opportunities for participation.

 
14. Your Personal Preference? (Please select).
*Please note - NON INVASIVE research basically means that NO medications are involved. If you are applying for a clinical trial don't select the NON INVASIVE Option.


 
15. When are You Available?


16. Where did you hear about this website? (Please be specific i.e. name of publication, or specific web link).  
 
Please note: (By law all information will be kept strictly confidential between intended parties). Can BioTrax forward this information on to Clinics/Researchers for the intended purpose of helping you to find a suitable research activity?
Yes: No:
Can Biotrax and Clinics/Researchers contact you regarding research info ?
Yes: No:

If you tick NO to any of the above questions we will not be able to assist you and you will NOT be registered on our database for future possibilities.
This is a general eligibility test for medical trials involving new medications and designed to save you an enormous amount of time, because if you do not pass this test you will not get onto any medical trial. It is built out of consideration for work seekers, and to speed up your decision making process, as well as save recruitment time for clinics.

Please note you will still have to register on clinics databases when they send out their forms, and you will still need to read the specific inclusions exclusions of the trial itself where given - ie. You need to be a smoker or a non smoker, for example - male or female etc

You will be redirected to our study site after application to apply directly to studies which may suit and only then will the specific clinic contact you. SO PLEASE WAIT to be redirected - You will not have to fill in forms again whilst you are on the site . Because of the high numbers off people changing email addresses phone numbers , starting to smoke etc , You will have to fill in any eligibility test again when you visit next time and this will then keep all your profile details up to date

Please read the SPECIFIC Inclusions and Exclusions where supplied on each study.

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BioTrax takes no responsibility for any inacuracies of details supplied by vistors to this site and will not be held liable as a result. This test has been reviewed by the Data Protection Act and Hipaa as being acceptable for this purpose. Privacy Policy  Security Policy

If you wish to OPT OUT at any stage click on the OPT OUT button on this page and all info you have provided on the eligibility test is completly removed from our database. If you wish to change your details I.E email address, smoking status, personal prefrences etc or re register at any stage, simply fill in the test again and it will automatically update your information.