Register Now Backpackers - Scientia Clinical Research

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Do you currently have any medical conditions?*

Yes

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Are you currently taking any medication?*

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SMS

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First name*

Last name*

Phone*

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We will give you a call to discuss this study with you and ask some screening questions to see if you might be eligible.

Email*

Gender

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Do you smoke?*

Yes

Socially only

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We have staff who speak English and Japanese.

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이름*

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전화번호*

선호하는 연락 시간대 – 날짜 및 시간*

임상 시험과 참여 조건에 확인을 위해 전화드리겠습니다.

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남자

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흡연을 하시나요?*

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아니오

소셜스모커 / 가벼운 흡연자

선호하는 언어*

영어와 한국어 구사가 가능한 직원이 있습니다.

영어

한국어

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