Apply for a COVID 19 Clinical Research Study

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Complete our Prescreening Questions

to see if you may qualify for one of our Clinical Studies.

All information is kept strictly confidential and is HIPAA protected.

We will contact you to let you know whether or not you qualify. If you do not qualify at this time, we may contact you in the future to notify you of new studies for which you may be eligible.

Have you had a test for COVID-19 and tested positive?

Yes

Do you live in a household with someone who just tested positive for COVID-19?

Yes

Do you work in a field with increased chances of exposure to COVID-19?

Yes

List all symptoms you are currenlty experiencing:

None

Cough

Fever

Sore Throat

Chills

Red Eyes

Fatigue

Weakness

Loss of Taste/Smell

Shortness of Breath

How long have you been experiencing above symptoms?

currently

within the last week

more than a week, but less than two weeks

more than two weeks

Check all conditions that apply to you that put you at higher risk of complications from COVID infection:

I am above 50 years of age

I am above average weight

I have cardiovascular disease

I have hypertension

I have chronic lung disease

I have asthma

I have type 1 or type 2 diabetes

I have chronic kidney disease

I have chronic liver disease

I am or may be pregnant

I have compromised immune system (ie: cancer treatment, transplant, immune deficiency, HIV, sickle cell anemia, thalassemia, use immune-weakening medications, etc)

None of the above apply to me

Thanks for submitting! We will get back to you soon to let you know if you qualify for any of the studies we currently have.

851 Broken Sound Pkwy NW, Suite 125, Boca Raton, FL 33487

BOCA RATON: (844) 204-8404

19 West Flagler Street, Suite M104, Miami, FL 33130

MIAMI: 305-503-9006

Complete our Prescreening Questions

to see if you may qualify for one of our Clinical Studies.

​

All information is kept strictly confidential and is HIPAA protected.

We will contact you to let you know whether or not you qualify. If you do not qualify at this time, we may contact you in the future to notify you of new studies for which you may be eligible.

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