199 S Monte Vista St 2, San Dimas CA, 91773 | [email protected] | +1 (213) 577-1261
Participant Intake Form
Submission of the form is in no way a consent to participate. The form is only a way for you to express interest. We will call you within 48 hours to discuss the trial and schedule an appointment. The doctors will meet with you, screen you, and ask for your consent in the office.
Personal Information
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Lifestyle & Demographics
Permission to Contact You
By checking this box, I consent to receiving communications and information about Clinical Clear’s services by email and text messages. We are committed to protecting your privacy and comply with HIPAA and all applicable consumer protection laws. Any information provided will be securely stored and used solely to assess eligibility for clinical trials or provide additional information about our services. Your information will never be sold, shared, or disclosed without your consent, and you may opt out of communications at any time. For questions or concerns, please contact us at [email protected].