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Be part of
groundbreaking
medical research
Help advance new treatments and improve lives through clinical trials.
Expression of Interest Form
This form takes around 3–5 minutes to complete. Your information will remain confidential and is used only to assess your eligibility for current or future research studies.
Contact Details
First Name
Last Name
Email
Phone
The phone number you have entered does not appear to be a valid active Australian phone number. Please check your details and enter a valid Australian phone number starting with +61
Postcode
VIC
QLD
Nucleus Network does not currently conduct clinical trials in your state.
If you would like to receive study information should this situation change, please complete and submit this form
Demographics
Date of Birth
Day
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You need to be at least 18 years old to participate in clinical trials.
Biological Sex at Birth
Male
Female
Height
cm
Weight
kg
Optional: what is your ethnicity or family history?
Please select...
Caucasian
Hispanic
Aboriginal or Torres Strait Islander
African or African-American
Middle Eastern
Indian
Japanese
Chinese
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Other
Unsure
If you selected 'Other', please specify
Date of Birth
Health Background
Are you a smoker?
How many cigarettes or equivalent nicotine containing products do you smoke?
Less than 5 per week
Less than 5 per day
Between 5 and 10 per day
More than 10 per day
Do you have a history of anaphylaxis or do you have any severe allergies to food or medication?
We define an allergy as severe if symptoms include mouth/throat/face swelling, shortness of breath or a whole-body rash, or if it required hospitalisation
Do you have a history of any other medical or mental health conditions? (e.g. Cancer, Hepatitis, eating disorders, high blood pressure, sleep apnoea)
We regularly have studies that allow for/require participants with medical conditions.
Which of the following conditions do you have/have you had?
Cancer
Coeliac disease
Diabetes - Type 1
Diabetes - Type 2
Epilepsy
Gastrointestinal problems
Hepatitis
HIV Positive
Liver problems
Psoriasis
Rheumatoid Arthritis
Eating disorder
Mental health condition
High blood pressure
High cholesterol
Other
Consent to Information Use and Future Contact
Please confirm
By registering your interest, you consent to Nucleus Network using the information you provide to assess your eligibility for a screening visit and to contact you about current or future clinical trial opportunities. You confirm that the information you provide is accurate and complete. You can unsubscribe at any time. View our
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Today
About
Leadership team
Medical leadership team
Careers
Participants
How it works
Find a trial
Sponsors
Global network advantage
Expertise
Resources
Resources
FAQs
News
Contact