4 Medical Park Dr, Fairhope, AL 36532

Mon - Thurs 8AM–5PM, Fri 8AM–4PM

251.990.1920

Take The 30 Second Screening

Take The 30 Second Screening

Participation is about more than research—it’s about contributing to better care for yourself and others.

Once your information is submitted, our research team will review it to determine whether you may qualify for a current study. If you are a potential candidate, we will contact you. If you do not qualify at this time, we may contact you in the future if a new study becomes available that may be a good fit for you. Participation in research studies is always voluntary.

Name
(We'll send your results for easy reference.)
(If you qualify, we would like to be able to contact you.)

Please provide the following information as accurately as possible.

Your responses will help our research team determine your potential eligibility for participation in this study. All information submitted will remain confidential and reviewed only for study qualification purposes.

Which of the following are your current or past medical history?
The following conditions are excluded from all studies: 
  • Substance abuse.
  • Cancer within the last 5 years requiring chemo.