Clinical Testing Registration
Clinical testing is offered Tuesdays and Thursdays, 10:00 a.m.–2:00 p.m. Complete this form and choose your preferred day. We will contact you to confirm the date, arrival time, and location.
First Name
*
First Name
Last Name
Last Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Upload Photo ID
*
Upload a File
Drag and drop files here
Choose a file
Upload a clear photo or scan of your ID.
Cancel
of
Preferred Testing Day
*
Tuesday — 10:00 a.m.–2:00 p.m.
Thursday — 10:00 a.m.–2:00 p.m.
Privacy, Consent, and Payment Acknowledgment
Your contact information and uploaded ID will be used only to verify your identity, coordinate clinical testing, maintain necessary participation records, and administer payment. Your information will not be sold or used for marketing or any unlawful purpose. Access will be limited to authorized personnel and service providers who need it for these purposes, or as required by law. Participation is voluntary. You will be paid upon completion of a successful blood draw. The payment amount, method, timing, and what constitutes a successful blood draw will be explained before you decide whether to proceed. Completing this registration alone does not qualify you for payment. Before any blood draw, staff will explain the procedure, its purpose, how your sample will be used, and the risks, and obtain any required separate informed consent. You may ask questions and decline the procedure.
Submit Registration
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