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Clinical Studies Eligibility Questionnaire

Return to Vaccine Clinical Studies

Thank you for your interest in Vaccine Research Center clinical studies

If you would like more information about participating in a study, you can contact us at 1-866-833-5433, vaccines@nih.gov, or by filling out this short questionaire.

Your answers will be kept confidential and will not be distributed.

1. Are you available for the next 6 to 12 months to participate in a Vaccine Research Center (VRC) study? (required)

2. Do you live within 100 miles of the Washington, DC, metro area? (required)

If you do not live within 100 miles of the metro DC area, you are not eligible to participate in VRC clinical studies. Please visit www.hvtn.org for information on preventive HIV vaccine clinical studies in your area, or visit www.clinicaltrials.gov for information on other studies for which you may be eligible.

3. How old are you? (required)

If you are under 18 or over 70 years of age, you are not eligible to participate in VRC clinical studies. Please visit www.clinicaltrials.gov for information on other clinical studies for which you may be eligible.

4. What is your gender? (required)

5. Are you pregnant or breastfeeding? (required)

If you are currently pregnant or breastfeeding, you are not eligible to participate in VRC clinical studies. Please visit www.clinicaltrials.gov for information on other clinical studies for which you may be eligible.

6. Are you comfortable discussing your sexual history with a clinician? (required)

7. Do you have a health problem that requires ongoing care by a doctor to prevent serious harm? (required)

If you have a serious health problem that requires active medical care, you are not eligible to participate in VRC clinical studies. Please visit www.clinicaltrials.gov for information on other clinical studies for which you may be eligible.

If you are interested in receiving more information about vaccine clinical studies, please provide your contact information.

First name (required)
Last name (required)
Phone number (required)
Email (required)
Best time to reach me
Additional comments
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Your answers will be kept confidential and will not be distributed.