Erectile Dysfunction Research Study

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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? *

Additional Details

Are you able to read, speak, and understand English? *

Do you normally wear corrective lenses, contacts, or glasses to read? *
If yes, you will need to have them available during your interview in order to participate.

Have you ever participated in a research study about a medicine for erectile dysfunction? *

Have you participated in another health-related market research study, product label study, or clinical trial in the past 12 months? *

Do you, or does anyone in your household work for a pharmaceutical, marketing research, or an advertising company? *

Are you, or is anyone in your household a healthcare professional, trained as a healthcare professional, or working as part of a healthcare practice? *

Are you or is anyone else in your household employed by PEGUS Research? *

Do you have a laptop, desktop computer, smartphone, or tablet with a video camera you use to access the internet regularly? *

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

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 and PEGUS Research 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 the AutoCruitment SMS Terms and Privacy Policy for texts sent by AutoCruitment and the Research privacy policy for texts from PEGUS Research. *

Yes

I was given the opportunity to review the PEGUS Privacy Notice. READ THE PEGUS PRIVACY NOTICE *

Yes

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.