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Cervical Health & HPV Study

Cervical Health & HPV Study

This survey will take no longer than 5 minutes (12 questions)  to complete and is intended to assess your eligibility for the KGK Science Clinical Trial. This clinical trial will investigate the safety and efficacy of Papillex on the regression of abnormal cervical cells caused by HPV. By pressing start, you are consenting to KGK Science asking you questions related to lifestyle and medical history regarding this study.  All information collected will be kept in accordance with our Privacy Policy.  https://kgkscience.com/about/privacy/ 

HIPAA

Compliance

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  • 4
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    Pick a Date
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  • 6
    (Sample was sent to the lab by a practitioner and a report was received.)
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  • 9
    Please select all that apply
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  • 10
    Please Select
    • Please Select
    • I have had a kidney stone in the last 6 months.
    • I had a kidney stone over 6 months ago and am symptom free.
    • I had a kidney stone over 6 months ago and am still having symptoms
    • I have had liver disease.
    • I have a kidney disease.
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  • 11
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  • 12
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    • My condition is stable, no changes in health in the last 3 months (no medication).
    • I am currently taking medication to control my condition (less than 3 months).
    • I have been taking medication to control my condition for over 3 months with no changes.
    • My doctor is currently changing medications to control my condition.
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  • 13
    Please select all that apply.
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  • 14
    Please select all that apply.
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  • 15
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  • 16
    Please select all that apply
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  • 17
    Name & Email
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  • 18
    Please select all that apply.
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  • 19
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