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FAQ Northwest Arkansas Clinical Trials Center

We are proud to offer you the opportunity to participate in research studies that may not only help your given condition but that also will further scientific knowledge.
At Northwest Arkansas Clinical Trials Center, we are proud to offer you the opportunity to participate in research studies that may not only help your given condition but that also will further scientific knowledge.

We conduct various types of studies at any given time, all within the field of dermatology.   Your participation in a research study is protected by HIPAA laws as well as being protected by ethical boards.  Your name is never used on study documents/samples, and insurance is not required to participate.  In addition, most studies offer compensation to account for your time spent volunteering in the study.

We are currently seeking participants for the following studies: acne, atopic dermatitis (eczema), hydradenitis suppurativa, and psoriasis.   Some of our past studies have been on rosacea, cutaneous lupus, warts, chronic hand eczema, in addition to the conditions mentioned above.  If we don’t currently have a study that you meet the criteria for, you may wish to be in our clinical trials database.  Please click here to print and complete the form.  We conduct both pediatric and adult studies, so feel free to complete a form on everyone in your family!  We are contacted frequently about new studies, and may have one for you in the near future! 

CLINICAL TRIALS INTEREST FORM

If you would like to be contacted in the future regarding potential study participation, please complete this form.  We are starting new studies on various conditions all the time!

Pt. name: ________________________________ Phone number(s):  (____)________________

Address: __________________________________ City: ___________ State: _____ Zip: ______

E-mail: ____________________________________   Height: _______ Weight: _______

Date of birth: _____________    Age: ________    Sex: ____  (M/F)

Allergies (including drug): _____________________________________   Smoke: _______(Y/N) 

Women: Date of last menstrual period: _________________  Hysterectomy: ______(Y/N)

Medications:___________________________________________________________________

______________________________________________________________________________

Derm Conditions (including diagnosis dates):_________________________________________

______________________________________________________________________________

Medical History (including diagnosis dates):__________________________________________

______________________________________________________________________________

Surgical History (including dates): __________________________________________________

______________________________________________________________________________

Comments: ____________________________________________________________________

______________________________________________________________________________

THANK YOU!

www.nwactc.com

500 S. 52nd St.

Rogers, AR 72712

Phone: 479.876-8205

Fax: 479.876.8049
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