Please submit your contact information
Thank you for completing the questionnaire. It appears you may qualify for the clinical trial. Please only provide your contact information in the form below and please click the submit button. A nurse from the study team will contact you to review eligibility and discuss the clinical trial.
Please, do not provide any information about anyone but yourself.
Privacy is very important to us. If we are unable to reach you, may we leave a message?%field:ext_privacy%
When you submit the contact information by clicking below, it is forwarded directly to the trial nursing team at Serva Health. Submitting this information is not a commitment to participate in the Apex or Summit clinical trial, but rather simply exploring the possibility of being able to participate if qualified.
By checking the box below, I understand that the personal information I have provided may be collected, shared, used and/or transferred to the clinical trial study team for the sole purpose of enabling me to be contacted to see if myself or the potential participant is eligible to take part in a clinical trial, and if appropriate, to assist in enrolling into the clinical trial. I acknowledge that I may withdraw interest in participating in a trial at any time by speaking with a member of the study team.
- The name and phone number I have provided belong to me, are correct, and that I am interested in participating in a clinical trial (in order to help prevent unauthorized use of this service).
- I am 18 years or older.
- I am the potential participant, or otherwise legally authorized to act on behalf of the potential participant.
- I agree to be contacted via phone, text, or email. Standard message rates may apply.