Clinical study interest form

A clinical study needs to find people who might qualify, but the form itself does nothing but collect interest and basic facts. Real screening — medical history, eligibility verification, informed consent — is a conversation with a study coordinator. This form asks the essentials — condition area, age range, availability for a screening call — so your team knows who to contact and what to expect from them.

The form beside this text is live. Fill it in and submit it — it validates exactly as it would for a real respondent, and saves nothing.

Dropdowns for age and availability prevent follow-up questions

An age-range dropdown means your team knows the category without asking "How old are you?". Availability windows mean you never schedule a call only to reschedule it — the respondent picked the window they can make.

A text block can clarify what the form is and is not

A form cannot enforce medical accuracy or informed consent. A text heading that says "This form collects interest only; a study coordinator conducts actual screening and consent" sets expectations and protects participants from mistaking the form for enrollment.

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Clinical Study Interest Form

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How to build this form

6 steps in the editor. Nothing here needs a paid plan.

Add name and email fields for identification.
Add a dropdown for condition or study area of interest — depression screening, arthritis management, diabetes monitoring, heart health, sleep research — so interested people self-identify.
Add a second dropdown for age range: under 18, 18–25, 26–40, 41–60, over 60. Age is often a screening criterion; a dropdown is cleaner than free text.
Add a dropdown asking "What is your availability for a screening call?" with options like "Weekday mornings", "Weekday evenings", "Weekends only".
Add a prominent FAQ or text paragraph: "This form collects interest only. A study coordinator will contact you to discuss eligibility, answer questions, and schedule a screening if you qualify. This form does not enroll you in a study or provide medical advice."
Export to CSV and have your team follow up with each interested person. The coordinator conducts the real screening — consent, medical history, eligibility determination.

Fields in this form

7 fields, using 5 of the 19 field types available.

Question	Field type	Required
Full name	Short text	Yes
Email	Email	Yes
Phone number	Phone	Yes
Which condition or study area interests you?	Dropdown	Yes
Age range	Dropdown	Yes
What is your general availability for a screening call?	Dropdown	Yes
This form collects your interest only. A study coordinator will contact you to discuss eligibility and next steps.	Heading	Optional

What goes wrong with this form

Specific to a clinical study interest form, not general advice about forms.

Not clarifying that the form is interest only

Add a text block at the top or bottom: "This form collects your interest in learning more about this study. Submission does not enroll you or mean you qualify." Respondents often read a form as the end of the process, not the start.

Asking for detailed medical history in the form

Do not ask "Describe your symptoms" or "List your medications". A coordinator needs that conversation. The form asks only what rules out interest entirely — age, condition category, rough availability.

Using the form responses to make screening decisions

Use the form to find who to call; let the coordinator make eligibility calls after talking to them. A text answer to "Do you qualify?" is not screening — a trained person reviewing medical history is.

Questions about this form

Can a form pre-screen someone into a clinical study?

No. A form collects interest and basic facts — age, condition area, availability. A trained study coordinator conducts the real screening: medical history, eligibility rules, informed consent. This form is the first step only.

What should the form say about medical information?

Make it explicit: "This form does not collect detailed medical information or provide medical advice. A study coordinator will contact you to discuss your medical history and eligibility if you are interested." Never let a respondent think the form is their screening or consent.

Can you use this form to collect consent?

No. Informed consent for a clinical study requires a trained coordinator to explain risks, benefits, alternatives and the right to withdraw — a conversation, not a form. Collect interest here; do consent in a real conversation.

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