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If you are interested in participating in the clinical trials currently advertised and are recruiting or would like us to add you to our database for future open studies, please e-mail volunteers@maximax.com. someone from our patient management and recruitment department will contact you for a confidential phone call to get your information. However, you could fill out the form below and our study coordinator will contact you for more detailed information.
Note: All required fields are marked with an asterisk (*)
Note: All required fields are marked with an asterisk (*)
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| *First Name | |
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| Middle Name | |
| *Last Name | |
| *Date of Birth | |
| *Address | |
| *City | |
| *State | |
| *ZIP | |
| *Phone | |
| *E-Mail Address | |
| *I am interested in participating in clinical trials in: (supply details) | |
| *I want to be contacted by: (phone, e-mail, etc.) |