Recruiting / Register online

If you would like more information regarding any of the trials that we are currently conducting, or would like to participate in a clinical trial, please call Dr. A Gupta (519) 657-4222 Ext. 277 to speak to one of our research coordinators or fill the following questionnaire and send it to us.  All of the information that you provide will remain confidential and will not be shared with others.

Name: E-mail: Phone: Street Address: City: Province/State: Country:   Gender: Male Female   Age:  18-30 31-45 46-55 56 or older   Height cm inches   Weight kg pounds   Do you smoke? Yes No   Have you participated In a study in the past?   Yes No   Can you swallow tablets and capsules? Yes No   Are you available on weekends? Yes No   Are you available on weekdays? Yes No   Can we contact you? Yes No