Food Allergy Study

Do you or someone you know have food allergies to peanuts, milk, eggs, wheat, walnuts, cashews or hazelnuts?

Would you like to take part in a Clinical Research Study for looking at investigational medications for food allergy in children and adults at no cost to you and be compensated for your time?

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

Participants will receive compensation for time and travel.

No health insurance is required to participate. All study-related treatments, medication and care will be provided at no cost. The study will involve visits to a clinic in your location.

Help get new therapies to market.

What happens if I sign up?

You or your child may be eligible for a Food Allergy clinical research study, also known as a clinical trial in your area. Someone from the study team or clinic conducting the trial will contact you to explain more about this research study before you make your decision about participating.

Sign Up

Fields marked with an * are required.

If you are under the age of 18 (you may not directly enter any information and your legal parent or guardian must enter this information on your behalf. By filling out this form, you are confirming that you or your child meet these requirements.

Who are you interested in this study for? *

First Name of Potential Participant *

Last Name of Potential Participant *

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

Zip Code or Postal Code of Potential Participant *

Are you – or the Potential Participant (if filling this out for them) - Male or Female? *

Are you - or the Potential Participant (if filling this out for them) – allergic to peanuts? *

Are you – or the Potential Participant (if filling this out for them) – allergic to any of the following food items? *
Please select all that apply.

Milk

Eggs

Wheat

Cashews

Hazelnuts

Walnuts

Have you – or the Potential Participant (if filling this out for them) – been diagnosed (by a doctor) with any other medical conditions? *
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

Are you – or the Potential Participant (if filling this out for them) – taking any medications for your Food Allergy in Children or Adults or other health conditions?
Please list them here or write 'none'.

If female, are you – or the Potential Participant (if filling this out for them) – currently pregnant or breastfeeding? *

Are you – or the Potential Participant (if filling this out for them) – currently participating in a clinical trial for an investigational drug or device? *

Name of Person to Contact *

Phone Number of person to contact *

Email of person to contact

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

Would you like to be contacted about taking part in a Clinical Trial that you – or the Potential Participant (if filling this out for them) - may qualify for? *

Yes

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.