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
Gender
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Lifestyle & Demographics
If your height is 5 ft 7 in, input 5.
If your height is 5 ft 7 in, input 7.