Intake Request

Share your clinical research interests.

Use this intake request form to provide basic contact details and general research preferences. Mobile number submission is optional, and SMS selections are optional.

Participant Intake

A more complete request form for research information.

This page is designed to gather general screening context so Core Point Research Group can better understand the type of information you are requesting.

1Submit basic contact details

2Select general research interests

3Choose optional SMS preferences

This form does not provide medical advice, confirm eligibility, or guarantee study availability.

Contact Information

Fields marked optional are not required to submit.

First Name

Last Name

EmailMobile Phone (optional)

Age Range

Gender

Research Preferences

These selections help organize your inquiry.

Primary Area of Interest

Best Availability

Preferred Contact Method

City / State (optional)Additional Notes (optional)

Optional SMS Preferences

These checkboxes are separate choices. You may submit this form without selecting either SMS option.

General Account NotificationsBy checking this box, I agree to receive account-related text updates from Core Point Research Group about my intake request and communication preferences. Message and data rates may apply. Msg frequency varies. I can reply STOP to opt out or HELP for help. Consent is not required for purchasing products or services. My number will not be shared with third parties or affiliates.

Marketing MessagesBy checking this box, I agree to receive marketing text messages from Core Point Research Group. Message frequency may vary, message and data rates may apply, and I can reply HELP for assistance or STOP to cancel. Consent is not required for purchasing products or services. My number will not be shared with third parties or affiliates.

Terms & Privacy AcknowledgmentI have reviewed and agree to the Terms and Privacy Policy. This acknowledgment is separate from optional SMS consent choices.

SMS checkboxes are optional and are not required to submit this form.

Thank you, your information has been submitted.