Paid Medical Research Study Participant Application

Paid Medical Research Study Participant Application — Form Fields

This applications template includes 10 fields. Apply to participate in a paid academic medical research study with eligibility screening. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email (email, required)
• Phone Number (text, required)
• Date of Birth (text, required)
• Biological Sex (dropdown selection, required) — options: Male, Female, Non-Binary, Prefer Not to Say
• Ethnicity (optional, for study diversity requirements) (dropdown selection, optional) — options: White, Black/African American, Hispanic/Latino, Asian, Native American, Pacific Islander, Other, Prefer Not to Say
• Medical Conditions (for eligibility) (checkboxes, optional) — options: Type 2 Diabetes, Hypertension, No Conditions, Asthma, Autoimmune, Other
• Currently Taking Prescription Medication? (multiple choice, required) — options: Yes, No
• Non-Smoker for at Least 6 Months? (multiple choice, required) — options: Yes, No
• Body Mass Index (BMI) if known (number, optional)