QUALIFICATION QUESTIONNAIRE

Studies are carefully designed to safeguard the health of the participant and all studies are approved by the South African Health Products Regulatory Authority (SAHPRA) as well as an independent Ethics Committee prior to implementation.

The Questionnaire below does not bind you to any trial commitment. Complete the form as thoroughly as possible. We will contact you if you are suitable to move forward to the next approval phase.

Click “Download Form” below if you are having difficulties with the online form.

Kindly Note: This form does not automatically enrol you into any trial obligations.

Gender

Do you have any chronic conditions for which you take regular medication?

Osteoarthritis

Rheumatoid arthritis

Psoriatic arthritis

Myocardial infarction (heart attack)

Hypertension

Crohn’s disease

Ulcerative colitis

Diabetes mellitus

--- Type I or II ?

High cholesterol

Skin diseases

COPD

Other

12 + 5 =