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Become a Patient Volunteer

Patient Pre-Screening Form.

Interested in joining a clinical study or have a question about participating? Start here. Our clinical coordinators review every submission and will reach out if you qualify for an upcoming study. It takes about 5 minutes, and there is no obligation to join.

Start Application
Pre-Screening Application

Four short steps to get started.

Answer a few questions about yourself, your health and your availability. A coordinator will review your answers and contact you about suitable studies.

1
Basic Information
Contact details
2
Health History
Conditions and background
3
Availability
Travel and visit times
4
Consent
Review and submit

Your information is strictly confidential and will never be sold or shared with third-party advertisers.

Questions? Call 708.289.3032
Step 1 of 4

Basic Information & Contact Details

Please provide your contact information so our clinical coordinators can reach out if you qualify for a study.

Step 2 of 4

Health & Medical History

Select any medical conditions you have been diagnosed with or are currently experiencing. This helps us match you with active or upcoming clinical trials.

Medical Background Questions
Step 3 of 4

Trial Availability & Preferences

Help us understand your availability and preferences for participating in a study.

Step 4 of 4

Consent, TCPA Compliance & Submission

Please review the authorization below before submitting your inquiry.

Legal DisclaimerBy submitting this form, you acknowledge that the information provided will be reviewed by clinical staff at Solutions Research Group to evaluate your eligibility for active and upcoming clinical trials. Your information is strictly confidential and will never be sold or shared with third-party advertisers.
Mandatory Consents (Required)