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Valley Surgical Center
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JOIN A
CLINICAL TRIAL
Inquire About a Study
(please only submit one inquiry)
First Name
Last Name
Phone
Email
Address
City
State
Zip
Birth Date
Current and Upcoming studies you are interested in (select multiple):
*
Required
Adhesive Capsulitis
Asthma
Bunion Removal
Diabetic Neuropathy
Diabetes
Healthy Volunteers
Hernia
Low Back Pain
Lumbar Radiculopathy
Hot Flashes
Knee Pain
Menopause
Migraine
Obesity with Knee Pain
Rotator Cuff Tendinopathy
Sciatica
Shoulder Pain
Tummy Tuck - (AZ Residents)
Temporomandibular Disorders (TMD)
Other - Please Specify Below
Gender at Birth:
Weight
Height
Ethnicity
Choose an option
Race
Choose an option
Preferred language
Choose an option
Are you taking any medications?
Do you have any medical conditions?
Do you consume any type of nicotine?
Choose an option
Do you consume any marijuana?
Choose an option
One of your studies of interest is Bunion Removal. To better assist you, please upload a photo of your affected foot. *This is not required.
Upload Photo
Upload supported file (Max 15MB)
How did you hear about us?
If referred by someone please provide their name and phone number.
I understand that by completing this questionnaire I am agreeing to be added to our database and to be contacted by our site via phone, text and email. You are able to opt out at any time.
Send Inquiry
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