St. Joseph's Medical Associates Research Department

Clinical Trial Application

Please complete the form below to learn about, or express an interest in, participating in a clinical trial through our medical facility.

The information you provide, will always be kept in strict confidence. Completing this form allows us to determine whether you meet the inclusion criteria for a particular study.

The "inclusion criteria" are made by the company sponsoring the clinical trial, not by our practice. More information and screening tests may still be necessary to confirm your eligibility.

Participation in a clinical trial is completely voluntary. If you complete this questionnaire you may be contacted to determine if you are interested in participating in a research study. If, at a later date, you decide you do not wish to be contacted for a clinical study, please contact us immediately at 209-939-3877.

By completing the form below I am indicating that I am interested in participating in one or more of the clinical trials. Different research studies are done at different times.

We may contact you when a study is being done in which you have indicated an interest. Please select from the following list, or add others of interest to you, which types of research studies you might wish to participate in:

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