Dry AMD Study

Do you have Macular Degeneration?

Would you like to help advance therapies for Macular Degeneration?

Sign up and we will notify you of clinical trials in your area that need patients with Macular Degeneration.

Volunteers who take part in the study may be compensated for their travel and time in the study.

No health insurance is required to participate. All study‐related care will be provided at no cost to you. The study will involve visits to a study site in your area.

What happens if I sign up?

We will match you to a clinical trial in your location that needs patients who suffer from Macular Degeneration or notify you when one becomes available. They will contact you and you will then have the opportunity to participate.

Sign Up

Fields marked with an * are required.

Are you filling out this screener on behalf of someone or for yourself? *

Please answer the below questions as though you are the potential study participant.

Potential Study Participant details:

First Name of Potential Study Participant *

Last Name of Potential Study Participant *

Date of Birth MM/DD/YYYY of Potential Study Participant *

ZIP or Postal Code of Potential Study Participant *

Have you/the patient been diagnosed with age-related macular degeneration (AMD)? *

There are two types of age-related macular degeneration (AMD), dry AMD and wet AMD. Which form do you/the patient have? *

Have you - or the potential study participant (if filling this out for them) – been diagnosed with Geographic Atrophy? *

Have you/the patient received an injection into the eye in the last 4 weeks to treat your AMD? *

Have you/the patient been diagnosed with any other eye diseases or medical conditions including wet AMD or diabetic retinopathy? *

Would you - or the potential study participant (if filling this out for them) - like to be contacted about taking part in a Clinical Trial? *

Would you be willing to provide consent and a saliva sample for genetic testing to see if you are eligible to participate in the SCOPE study? *

Name of Person to Contact *

Phone Number *

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

The information you are providing here will only be used to match you or a loved one to a clinical research study in the potential participant’s area and contact you to see if you or a loved one would like to participate. Please note the information you enter will be kept private, except when ordered by law, and only accessible to our Clinical Research Partners and affiliates and applicable regulatory agencies. If you have any questions regarding the handling of the information you have provided to autocruitment.com, or if you would like to make any changes, please contact us at info@autocruitment.com.

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