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.


Sufferers of Diabetes can register on our database for free on this page. There is no real way to give you an instant answer, as there are so many different research activities that require individual considerations. By completing the registration form however, this enables us to pin point more accurately which studies you will be eligible for. Our study site may include the specific inclusions and exclusions of research studies for those wishing to see if you fit the general bill. View present Clinical Trials by clicking this link
http://www.biotrax.com/clinical_medical_trials_select.php
Medical Trials for Diabetes 1 or Diabetes 2 are the most common of research activities conducted throughout the UK, US, and the World. If you need more info on Diabetes and medical trials research, click on this link
http://www.biotrax.com/diabetes.php
for helpful hints on your conditions and speak to other sufferers on forums boards.



BEFORE YOU DO, TELL A FRIEND. HELP BUILD OUR UNITY.
 
Volunteer Registration.
Please complete the form below and submit:
First Name:      
Middle:      
Surname:      
First Line of Address:      
Second Line of Address:      
City:      
Country:      
Postcode/Zip:      
Date of Birth: Age:
Race:      
Sex:      
Phone No:
Mobile No:
Email:
Please Note
So that clinics can contact you we do need at least one method of contact although both a phone number & email address will expediate contact and information delivery.
         
     
1. With the exception of Asthma ,Do you suffer from any Medical Conditions? (If yes please specify)
Yes: No:
2. With the exception of Asthma have you ever suffered from any serious illness, including heart problems or murmurs (if yes please specify)

Yes: No:
3. Do you have Asthma?
Yes: No:
 
4. Have you ever suffered from a Thyroid problem or Hepatitis?
Yes: No:
 
5. With the exception of Asthma treatments, and the contraceptive pill for women, Do you take any regular prescribed medication? (If yes please specify)
Yes: No:
6. Is your Blood Pressure High or Low? (If Yes please specify)
Yes: No:
7. Have you taken any recreation drugs in the last 28 days? *Please note you are required to abstain from social drugs for a minimum period of 28 days prior to participation in medical trials. If you are willing to do this leave the question ticked no.
Yes: No:
 
  
8. Please check your BMI value using the calculator supplied. If you do not know your exact measurments continue to question NO 9    
  Height Ft   In  Weight St Lb 
  
9. Is your Body height and weight in proportion? (If so please click Yes)
Yes: No:

  
10. Do you smoke? (If Yes please specify how many per day) *For Medical trials it is better to be under 10-15 cigarettes per day.
Yes: No:
  
11. 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 21-28 units a week.
12. Are you a vegetarian?
Yes: No:
 
13. (UK citizen Volunteers) Are you registered with a GP in this country? You will need to do this to participate in medical trials.(If not are you willing to be registered with one?)
USA Residents
Will not require any doctors registration.


Yes: No:
Please Note
If you are visiting the UK, London is the only city where you can use your overseas doctors registration details. You will require there name and fax number.
14. Women only. Do you use contraception? (Please specify)
Yes: No:
15. Women only. using the drop down box please select which category applies to you.

 
   
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:


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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.
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 please email Biotrax at eligibility@biotrax.com