Please note that all studies are conducted in Charlotte, NC and surrounding areas. If you live outside this immediate area, please refer to www.centerwatch.com for other similar studies located in your geographic area. You can reach us at 704.366.3001.

This information is kept confidential and used only by employees of Carolinas Research Associates for the purpose of contacting you regarding a study for which you may qualify. See our privacy policy for more information regarding use of information submitted.


First Name*:
Last Name*:
Date of Birth*:
Address*:
City*:
State*:
Zip Code*:
Phone*:
Email Address*:
Please select your current medical condition(s)*:
(Hold down CTRL to select more than one)
 
Other Conditions not listed above:
 
Questions or comments:
 
Would you like to be in our database? (If Yes, we will put the information provided above into our
system, and you will receive quarterly newsletters updating you on out current studies.) You do not have to be
included in our database to receive the information for you request today.
 
How did you hear about us?
 
If other, please tell us how did you hear about us:
 
Please type in the security number displayed above: