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Volunteer Participant Form

Cutting Edge Research appreciates your interest in participating in our clinical research trials. Please fill out the form below to add your information to our database. We will contact you when your profile is a potential match for a clinical study. Your information will be kept confidential unless given permission or except as required by law and you will only be contacted for participation in clinical studies at Cutting Edge Research.

Name of Potential Patient:
 * required
If a Minor, Name of Parent/Guardian:
Date of Birth:
 * required
Address:
City, State, Zip:
Main/Home Phone:
 * required
Alternate/Cell Phone:
Email Address:
Select Gender:
How did you hear about Cutting Edge Research?
Please specify channel, newspaper, website, etc.

Please select any condition below that you (or your child) have and would be interested in participating in a clinical trial.

ADHD
Alzheimers
Anxiety
Autism
Bipolar Disorder
Chronic Pain
Depression
Insomnia
Migraines
Obesity
Schizophrenia
Smoker
By submitting this form, you agree to your (or your child's) name and information being placed in our volunteer research database for potential placement in clinical research trials at Cutting Edge Research. We appreciate your interest in clinical research and taking the time to complete this form. Please click on the submit button to add this profile to our database.
Show a print version

You can fax a printed form to (405) 603-8069
or call our Research Participation line at (405) 603-8196.


Cutting Edge Research Group
6613 North Meridian Avenue, Oklahoma City, OK 73116
(405) 603-8068
Advancing Medicine. Changing Lives.

2011 Cutting Edge Research Group. All rights reserved.