Be the first to learn about upcoming clinical research studies!
Interested in potential upcoming studies? Please complete this form to be added to our contact list and to help assess eligibility. Completion of this form is entirely voluntary and you can choose to discontinue at any time.
Date of Birth
DD dash MM dash YYYY
Are you male or female?
Ethnicity: Select all the apply
Do you have diabetes?
Yes, Type I
Yes, Type II
Do you regularly smoke cigarettes (including e-cigarettes)?
Do you regularly smoke marijuana?
I provide consent for INQUIS to maintain the personal information provided in this survey and to contact me about participation in future studies.
This field is for validation purposes and should be left unchanged.