Become a volunteer at CMAX

Please read our Clinical Trial Privacy Policy

Please complete the registration form below:-

 
Name *
Name
Sex *
Address *
Address
Do you drink alcohol?
How many drinks (on-average) do you drink per day
Are you a smoker?
Do you have an allergy to any food or medications?
Do you take any medication on a regular basis?
Females only: Are you either post-menopausal or surgically sterile?
Females only: If NO, are you currently taking a form of contraception?
Do you suffer from or have a history of any of the following?
*
*
*