(682) 651-1112
Find a Clinical Trial
|
Check Your Eligibility
|
Join Our Clinical Trial Registry
|
Sponsors & CROs
|
Contact Us
Home
Clinical Trials
Find a Clinical Trial
Check Your Eligibility
Join Our Clinical Trial Registry
How Clinical Trial Participation Works
Participant FAQs
Provider Referrals
Areas of Focus
Liver Disease
Metabolic Health & Obesity
Cardiometabolic & Vascular Health
Immunology & Inflammation
Early Phase & Pharmacokinetic (PK) Studies
Sponsors & CROs
Why Sponsors Partner With Evidentis
Capabilities & Infrastructure
Startup & Feasibility
Quality & Compliance
Request Feasibility
Consulting & Advisory Services
Strategic Partnerships
About Us
About Evidentis
Meet The Team
Research & Publications
Careers
Location & Hours
Contact Us
(682) 651-1112
Find a Clinical Trial
|
Check Your Eligibility
|
Join Our Clinical Trial Registry
|
Sponsors & CROs
|
Contact Us
Home
Clinical Trials
Find a Clinical Trial
Check Your Eligibility
Join Our Clinical Trial Registry
How Clinical Trial Participation Works
Participant FAQs
Provider Referrals
Areas of Focus
Liver Disease
Metabolic Health & Obesity
Cardiometabolic & Vascular Health
Immunology & Inflammation
Early Phase & Pharmacokinetic (PK) Studies
Sponsors & CROs
Why Sponsors Partner With Evidentis
Capabilities & Infrastructure
Startup & Feasibility
Quality & Compliance
Request Feasibility
Consulting & Advisory Services
Strategic Partnerships
About Us
About Evidentis
Meet The Team
Research & Publications
Careers
Location & Hours
Contact Us
Join Our Clinical Trial Registry
Sex:
Female
Male
Intersex
Race/Ethnicity:
White (Hispanic or Latino)
White (Not Hispanic or Latino)
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaskan Native
Black or African American
Other
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Argentina
Australia
Belgium
Brazil
Canada
Chile
Costa Rica
Dominican Republic
East Africa
France
Germany
Greece
Honduras
Hungary
India
Ireland
Italy
Kenya
Lebanon
Mexico
New Zealand
Netherlands
Panama
Poland
Portugal
Puerto Rico
Romania
Rwanda
South Africa
Spain
Sweden
Switzerland
Turkey
Ukraine
United Kingdom
Medical History
Fatty liver disease (MASLD / MASH / NASH)
Alcohol-related liver disease
Hepatitis C
Hepatitis B
Cirrhosis or advanced liver disease
Other liver condition (not listed above)
Diabetes or prediabetes
High blood pressure
High cholesterol
Obesity or weight-related health concerns
Heart disease
Kidney disease
Cancer (past or current)
None of the above
Not sure
How often do you currently drink alcohol?
Never
Less than once a month
1 to 3 days per month
1 to 2 days per week
3 to 4 days per week
5 or more days per week
Prefer not to answer
On days when you drink, about how many drinks do you usually have?
1
2
3 to 4
5 to 6
7 or more
Not sure
Prefer not to answer
I agree to the following:
I agree to have my information stored in the Evidentis Clinical Research registry and to be contacted about current or future studies. I understand that I am not enrolling in a study by submitting this form.
