New Volunteers

Register for a clinical trial at Quotient Sciences - Miami

Before you start, you must be:

Over 18 years of age
Living in the United States
Generally fit and well
Not pregnant or breastfeeding
Free from a history of taking illegal drugs or alcohol abuse

Filling the form should not take more than a few minutes. Be as honest as possible when you are answering the questions. Trouble accessing the form, or have a question about the process? Contact us directly by calling +1-305-646-6785.

Have you volunteered with us before?

YesNo

When did you last volunteer with us?

What is your name?

Title

First name

Please enter your first name as it appears on your identification.

Middle or Second Name

Please enter your middle or second name as it appears on your identification.

Last name

Please enter your last name as it appears on your identification.

Do you have a preferred name?

If you have a preferred name, please enter it here.

How can we contact you?

Email

Preferred phone number

Please enter the best number where we can reach you.

Alternative phone number (optional)

Please enter a secondary number where we can reach you.

What is your address?

Home Address - Street

Apartment or building number

City

State

Zipcode

Your personal details

Birthday

You must be 18 years of age or older to participate in a clinical trial with Quotient Sciences.

Height (in)

Weight (lbs)

Your Calculated BMI

Notice

Qualified

Not Qualified

Gender

Are you pregnant or breastfeeding or have you been pregnant in the last 6 months?

If you are pregnant (or have been in the last 6 months) or breastfeeding, then you would not be eligible to participate in our studies. Unfortunately, that means that you're ineligible for this trial, this time around. You can, however, still refer a friend.

Do you currently use any tobacco products? For example: Cigarettes, vapes, chewing tobacco or snuff, cigars, tobacco pipes, clove cigarettes or bidis, nicotine replacement products such as gum or patch, or any other tobacco or nicotine containing products.	Have you smoked or used tobacco products in the last 12 months? For example: Cigarettes, vapes, chewing tobacco or snuff, cigars, tobacco pipes, clove cigarettes or bidis, nicotine replacement products such as gum or patch, or any other tobacco or nicotine containing products.
Please provide more information about your smoking history:

Do you have any medical conditions?

Please provide more information about any medical conditions you manage:

Do you take any medication?

Please provide more information about any medications you take:

Almost done! Just a few final questions to complete your submission.

Following your submission, a member from our team will review your form and may have additional questions as part of the screening process. When is generally the best time to reach you?

MorningsAfternoonsEveningAny time

What is your preferred method of communication?

EmailMain phone numberAlternative phone number

How did you hear about us?

For other, please specify:

All personal data that you provide us with is kept in accordance with our Privacy Policy. We will ensure that it is kept safe and secure, kept no longer than is necessary, and we will never sell your information to a third party.

I agree to be contacted by Quotient Sciences regarding my application.

If you have volunteered with us before, please complete the existing volunteer form.

Click here to access existing volunteer form.

New VolunteersRegister for a clinical trial at Quotient Sciences - Miami

Before you start, you must be:

Your personal details

Almost done! Just a few final questions to complete your submission.

New Volunteers

Register for a clinical trial at Quotient Sciences - Miami