What is your ethnicity or family history? Please select...
Black
White
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American Indian or Alaska Native
Asian
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Native Hawaiian or Pacific Islander
Other Asian
Unsure
Prefer not to answer
Are you sexually active with a partner/partners of the opposite sex?
We have strict contraception requirements to ensure that your partner does not become pregnant while the study medication is in your system. During the study, are you willing to adhere to one of the contraception options below?
Using a condom + your female partner(s) using a separate form of birth control.
You or your partner(s) had a vasectomy/hysterectomy
Your partner(s) are post-menopausal
Abstinence from heterosexual sex for at least 1 month prior to screen and throughout study
We have strict contraception requirements for our studies to ensure that you do not become pregnant while the study medication is in your system. During the study, are you willing to adhere to one of the contraception options below?
You using birth control + your male partner(s) using a condom
You or your partner(s) had a hysterectomy/vasectomy
You are post-menopausal
Abstinence from heterosexual sex for at least 1 month prior to screen and throughout study
Have you ever required treatment by a medical professional for anaphylaxis and/or a severe acute allergic reaction?
Are you currently taking medication for depression or anxiety?
Do you have a history of asthma?
Do you have a history of any other medical or mental health conditions? (e.g. Cancer, Hepatitis, eating disorders, high blood pressure)
Which of the following conditions do you have/have you had?
Have you had a kidney and/or liver transplant?
Have you ever had a kidney stone?
Do your medical records indicate any stones as calcium oxalate?
Would you be able to provide us a copy of these medical records?
This study requires urine collection: are you willing to provide 24-hour urine collection?
This study requires a specific diet (similar to low carb diet); are you willing to follow this diet for the duration of the study?
Are you using insulin for your diabetes?
Apart from hormonal contraception, are you currently taking any prescription medications?
How did you hear about us? Please select...
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A Previous study
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Doctor referral
Mailing Address
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OR
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By completing this form you express your interest in participating in a clinical trial of new medication.
Before your potential participation you will speak with our Recruitment and Medical teams who will answer all of your questions.
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