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  • Do I Pre-Qualify?

    In order to determine if you meet the initial criteria for this clinical research study, a number of confidential questions about your health history and present condition must be answered. This should take about 5 minutes of your time.


    Do you want to continue?

    YesNo

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  • How Did You Find Us?

    How did you learn about this website?

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Pre-Screening Questions

  • 1. What is your age?

  • 2. Have you been diagnosed with Open Angle Glaucoma or Ocular Hypertension in both eyes by your eye doctor?

    YesNo

  • 2a. Do you require treatment to lower pressure in both eyes?

    YesNo

  • User Agreement: By checking the box below, I understand that the personal information I will provide may be collected, shared, used and/or transferred by the research study site and its staff for the sole purpose of enabling me to be contacted to see if I am suitable to take part in this research study and, if appropriate, to assist me in enrolling in this research study. I understand there is no guarantee that I will be contacted by a study nurse as a result of submitting my personal information. I acknowledge that I may withdraw my interest in participating in the research study at any time by speaking with a study nurse or research study site employee/representative.

     
    The pharmaceutical company will not sell or share my information with third parties for their own separate use.
    By checking this box, I verify that the name and phone numbers I will provide belong to me, are correct, and that I may be the interested candidate for this research study (in order to help prevent unauthorized use of this service.)By checking this box, I verify that I am over 18 years old.By checking this box, I confirm that I have read and understood the Legal Notices and Privacy Statement.

  • Submit

Confirm your location

  • How far are you willing to travel to participate in this study?

  • Please confirm your Zip code

  • Submit
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Thank You

Based on the answers you gave, you may be eligible to take part in this research study.

A patient care coordinator will contact you within the next 24-48 hours to discuss this study further and complete a short pre-qualification screen to determine if you may be a candidate for this study.

Please rest assured that all efforts to contact you are handled discretely and your confidentiality is always strictly protected. Voice mails and messages will not disclose the nature of the study.

Please click next to confirm contact information.

Next

Verify Contact Information

Please verify your contact information in the form below and then click the button to submit your information.

First Name:*

Last Name: *

Address 1:*

Address 2:

City:*

State:*

Zip or Postal Code:*

Phone Number:*[xxx-xxx-xxxx]

E-mail:*[xxxx@xxx.xxx]

Best time of day to contact you: *
MorningAfternoonEveningNight

Your privacy is very important to us. If we are unable to reach you in the future may we leave a message?
YesNo

When you submit your contact information by clicking below, your information will be saved into the system and set up for a call by one of our study nurses. By submitting this information, you are not committing to volunteer for this study. You are simply exploring an opportunity to join the study.

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