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Lucas Research
Clinical Research Questionnaire

Thank you for your interest in clinical research.  Please answer the following questions so that we can better understand your eligibility.  After your information is reviewed we will contact you as soon as possible.

Please share your email with us if you would, we promise never, ever to share it with anyone else.  We use email for critical correspondence like appointment reminders, office closing information and special announcements.
We will rarely email you more than 2-3 times per month.  Thank you!
Diabetes Questions (if non-diabetic, skip to question 11)
13. Do you have/have you had (check all that apply)...
16. Where did you hear about us (check all that apply)?