Major Depressive Disorder Clinical Trials

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

Personal Information

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 say

Health History

Have you been diagnosed by a doctor with Major Depressive Disorder (MDD)? *

Yes - diagnosed with MDD

No

In your lifetime, have you been diagnosed by a doctor with any of the following conditions? *
Please select all that apply.

Psychosis

Schizophrenia

Bipolar disorder

Seizures (this does not include febrile convulsions: seizures that happened during childhood when you had a fever)

Post-traumatic stress disorder (PTSD)

Obsessive-compulsive disorder (OCD)

None of the above

Have you been diagnosed by a doctor with any other medical conditions? *  
Please list them below or type ‘none’.

(Example: HIV, Hepatitis B, Hepatitis C, epilepsy, seizure)

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

(Examples: Auvelity, osavampator, ketamine, esketamine)

Additional Details

Do you consent to receive recurring messages at the phone number you provided above, including SMS/MMS text messages, sent by or on behalf of AutoCruitment through the use of an autodialer or artificial intelligence with information about research studies for which you may be eligible? To opt out, reply “STOP”. For customer care or support, text “HELP”. Message and data rates may apply. Message frequency varies. By clicking “Yes”, you also agree to our SMS Terms and Privacy Policy. *

Yes No

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. 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.

Major Depressive Disorder Clinical Trials

Study benefits include:

You may qualify if you: