Important medical research studies to evaluate a medication for depression


Participating cities:

Arizona Scottsdale California Arcadia Encino Garden Grove Irvine National City Newport Beach Oceanside Colorado Denver Connecticut Norwich District of Columbia Washington Florida Jacksonville West Palm Beach Georgia Roswell Kansas Overland Park Massachusetts Fall River Nebraska Omaha New Jersey Cherry Hill New York Bronx Mount Kisco New York Ohio Dayton Oregon Portland Tennessee Memphis Texas San Antonio Vermont Woodstock Virginia Richmond Washington Bellevue Seattle

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What is a Medical Research Study?

Pre-Qualifying Questionnaire

To see if you may qualify for this medical research study,
please complete this Pre-Qualifying Questionnaire.

These questions are to be answered by the person who would be enrolled in the research study if they qualify. If you are visiting this website for someone else, please provide this website link to them so that they may complete the questionnaire.

As used in these questions, "you" or "your" refers to the person who would be enrolled in the research study if they qualify.

How did you hear about this research study?

Please enter your home or work zip code. This zip code will be used to locate a study clinic near you. Please provide the zip code that would be most convenient to you.

Enter 5-digit zip code

What is your date of birth?

Month
Day
Year	ex. 1954

Are you male or female?

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What is your approximate height and weight without shoes?

What is your height?
Feet: Inches:

What is your weight?
lbs:

6.	Have you been in a drug research study within the last 90 days?
	Yes No Unsure

7.	Do you have a pacemaker?
	Yes No

8.	Have you had a heart attack in the past year?
	Yes No Unsure

9.	Are you currently experiencing a depressive episode?
	Yes No Unsure

10.	Are you currently taking a prescription medication for depression?
	Yes No Unsure

Privacy Policy: If you pre-qualify for this research study, you will be given a choice to submit your contact information, along with your answers to the questionnaire, to a study clinic conducting this research study. Except as noted above, no personally-identifiable information will be taken from you and your answers will remain confidential. We will not use your information for any purpose other than to screen you for potential participation in this research study. If you provide your or a friend's/family member's email address, the email address will not be provided to anyone other than the person to whom the email was sent as specified in this website. The person in charge of privacy for this website is the Privacy Officer, who may be contacted at 6207 Bee Caves Road, Suite 288, Austin, Texas 78746 or privacy@tprausa.com to make any updates to your information or to have your information removed.

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