Intake form

Name *

Email address *

What is your age range?

What is your gender?

What is your primary area of interest in medical research?

Please select at least one option.

Clinical Trials

Drug Development

Medical Devices

Health Technology

Public Health

Genetics

What health conditions are you interested in?

Please select at least one option.

Cardiovascular

Neurological

Oncological

Metabolic

Autoimmune

Infectious Diseases

Have you previously participated in any medical research studies?

Please specify how you heard about us.

What is your preferred method of communication?

Please select at least one option.

Email

Phone

Video Call

In-person

Do you have any specific questions or topics you would like to discuss?

Additional questions or comments

https://dr-remy-medical-research innovation