Would you like to participate in a clinical research study? (this survey will take approx. 5 minutes to complete)

Clinical research studies are the formal, scientific testing of new medical procedures, medications and devices. The Wesley Research Institute conducts a wide range of studies in many therapeutic areas that require the participation of volunteers.

Both healthy participants and people who have been diagnosed with a disease are invited to join our research database. Please complete the registration form below to record your interest in participating in a study.

          Mandatory *
First Name: * Surname: *
Home Phone: * Date of Birth: * / /
Mobile: * Work Phone:  
Email: * Ethnicity: *
Postal address *      
Smoker: * Yes No If yes, how many per day?  
Alcohol: * Yes No If yes, how much per week?  
Gender: * Male Female      
Height: * centimetres Weight: * kilograms
Current medications:   I am a healthy volunteer

or
 
I have a medical history  
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Your privacy is important to us and your details will remain confidential.
Click here for The Wesley Research Institute Privacy Guidelines

For further information or assistance, please contact The Wesley Research Institute Clinical Trials Centre on 07 3721 1523 or email clinicaltrials@wesleyresearch.com.au.

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