Sign Up for Future Studies Complete this form if you are interested in participating in our research studies. We will contact you with more information about any studies you would like to learn about. First Name Last Name Email DOB Phone Zip / Postal Code Sex at Birth Female Male Gender Female Male Transgender Female Transgender Male Non-Binary Ethnicity Hispanic/Latino Not Hispanic/Latino Race White/Caucasian Black/African American Asian Indigenous People/Alaskan Native Native Hawaiian/Other Pacific Islander Hispanic/Latino Middle Eastern/North African Multi-Racial Pronouns She/Her He/Him They/Them She/They He/They Preferred Language English Spanish Vietnamese Cantonese Mandarin Korean Best Contact Method Phone Text Email How Did You Hear About Us? Please select Billboard Clinic Patient Craigslist Email Facebook Family Member Flyer Friend Google Ad MyLocalStudy.com Newspaper Radio Self Studykik TrialFacts Website Study Types (CTRL/CMD for multiple) Birth control Ovulation Migraines/headaches Hot flashes Vaginal dryness Sexual dysfunction (i.e. low libido, anorgasmia, etc) Bladder control Stress Urinary Incontinence (SUI) Urge Based or Overactive Bladder (OAB) Vulvodynia Endometriosis Fibroids PCOS Heavy periods Painful periods PMD/PMDD Infections (Yeast, BV, Herpes, etc.) Generally health patient studies Single blood draw studies Vaccine studies Pre-menopausal Regular periods Irregular periods Post-menopausal (no period for >1 year or surgically) Hysterectomy (removal of uterus) Removal of ovaries Best Time to Reach You Morning (8 - 11AM) Lunchtime (11AM - 1PM) Afternoon (1 - 5PM) Evening (After 5PM) Significant Medical Conditions: Send
