Alzheimers Studies

Were you diagnosed with preclinical Alzheimer’s? Do you worry about your cognitive abilities?

Consider a research study focusing on symptoms of Alzheimer’s Disease

The Alzheimer’s Clinical Trials are assessing investigational medication that may help preserve cognitive abilities. If you are 55-75 years of age, and have been diagnosed with preclinical Alzheimer’s, and do not show signs of mild cognitive impairment, you may qualify.

Participants will receive study-related care from a team of experienced doctors and nurses. In addition, you may also receive reimbursement for study-related expenses.

What happens if I fill out the questionnaire?

If you qualify, we will match you to a clinical research study center that is seeking patients with preclinical Alzheimer’s or notify you if one becomes available. Someone from the study team will contact you to explain more about the studies and see if you are eligible.

If after talking to the study coordinator you decide to participate in the study, you will be asked to read and sign a consent form which provides detailed information including your rights, risks, benefits, and requirements of the study.

See if you may qualify

Fields marked with an * are required.

Do you consent to the collection and processing of your personal data (including information about your race and ethnicity (as applicable), and your health information, including symptoms, diagnoses, medications, and treatments and our sharing of this information (“Health Data”) for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested, and disclosure to our Research Partners? You may withdraw your consent at any time by contacting us at info@autocruitment.com. Please note that your revocation will not impact any records or health data already collected, disclosed, or processed based on your consent. If you do not consent to the collection and use of your Health Data in this manner, we will not be able to provide you with our services or evaluate your eligibility to participate in the studies. *

Yes

By clicking “I accept” below, you agree to receive calls or text messages from or on behalf of Velocity Clinical Research, Inc., regarding clinical research study opportunities at the phone number provided. These calls or text messages may result in data usage and/or charges. Frequency of texting may vary. You may reply with STOP to a text message. For full details, refer to Velocity's Privacy Policy. *

I Accept

First Name *

Last Name *

Phone Number *

Email *

Date of Birth MM/DD/YYYY *

Zip Code *

What sex were you assigned at birth? *

Male

Female

Prefer not to answer

Do you have a diagnosis of Alzheimer's Disease, or have you been told that you are at a high risk of developing Alzheimer's? *

Yes - diagnosed with Alzheimer’s

Yes - at high risk of developing Alzheimer’s

No

Unsure

Have you been diagnosed (by a doctor) with other medical conditions? *
(For Example: Cancer, Parkinson’s Disease, Multiple Sclerosis, Down’s Syndrome, schizophrenia, bipolar disorder, stroke, dementia)
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

Are you taking any medications or treatments for your Alzheimer’s or other health conditions? *
Please list them below or type 'none'.

Would you be interested in completing a memory test? *

Yes - interested in a memory test

No

Which racial or ethnic group(s) do you identify with? *
Capturing information on ethnic backgrounds allows us to better understand how different groups may have different needs.
Please select all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Hispanic Latino or Spanish

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Mediterranean (Greek/Italian/Portuguese/Spanish/etc)

Another race or ethnicity

I prefer not to answer

What is the best day/time and method to reach you (we know you are busy)? *

The information you are providing here will be processed in accordance with our Privacy Policy, which describes our data privacy practices, including how we share your information with our Research Partners and use your information to send you details about potential clinical trial opportunities. When you submit this information, you consent to AutoCruitment’s use of your data as described in our Privacy Policy. By providing your phone number and clicking “Submit” below, you consent to receive messages, including SMS/MMS text messages, sent by or on behalf of AutoCruitment, with information about research studies for which you may be eligible. By clicking Submit, you also agree to our SMS Terms. If you have any questions regarding the handling of the information you have provided to AutoCruitment, or if you would like to make any changes or withdraw your consent, please contact us at info@autocruitment.com.

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