Apply for a Clinical Research Study

Complete our prescreening questions

to see if you may qualify for one of our clinical studies or research projects.

All information is kept strictly confidential and is HIPAA protected.

We will contact you to let you know whether or not you qualify. If you do not qualify at this time, by submitting this form, you are giving us permission to contact you in the future about the studies or research projects for which you may be eligible.

Have you had a test for COVID-19 and tested positive?

Yes

No

Do you live in a household with someone who just tested positive for COVID-19?

Yes

No

Do you work in a field with increased chances of exposure to COVID-19?

Yes

No

List all symptoms you are currenlty experiencing:

None

Cough

Fever

Sore Throat

Chills

Red Eyes

Fatigue

Weakness

Loss of Taste/Smell

Shortness of Breath

How long have you been experiencing above symptoms?

currently

less than a week ago

more than a week but less than two weeks

more than two weeks

I am not experiencing any symptoms

Check all conditions that apply to you that put you at higher risk of complications from COVID infection:

I am above 50 years of age

I am above average weight

I have cardiovascular disease

I have hypertension

I have chronic lung disease

I have asthma

I have type 1 or type 2 diabetes

I have chronic kidney disease

I have chronic liver disease

I am or may be pregnant

I have compromised immune system (ie: cancer treatment, transplant, immune deficiency, HIV, sickle cell anemia, thalassemia, use immune-weakening medications, etc)

None of the above apply to me

Let us know of the conditions that apply to you or the diseases you have been diagnosed with:

Acne

Asthma, COPD, emphysema

Alzheimer's disease

Celiac Disease

COVID-19 current infection

COVID-19 past infection (COVID antibodies positive)

Diabetes type I

Diabetes type II

I have dietary restrictions (ie: Keto diet, Paleo diet, Gluten-free diet, Carnivore diet, other)

I have or suspect to have the flu

I am completely healthy with no known medical conditions

Hepatitis

High Body Mass Index

High glucose

HIV with viral load

HPV

Hypertension

Lupus, SLE

Multiple Sclerosis

Rheumatoid Arthritis

STD's men's

STD's women's

Thyroid disease

Ulcerative Colitis and/or Crohn's disease

Zika virus

Which Xera location is closer to you?

Thanks for submitting! We will get back to you soon to let you know if you qualify for any of the studies or research projects we currently have.

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851 Broken Sound Pkwy NW, Suite 125, Boca Raton, FL 33487

BOCA RATON: 561-334-2126

19 West Flagler Street, Suite M104, Miami, FL 33130

MIAMI: 305-503-9006

Complete our prescreening questions

to see if you may qualify for one of our clinical studies or research projects.

​

All information is kept strictly confidential and is HIPAA protected.

We will contact you to let you know whether or not you qualify. If you do not qualify at this time, by submitting this form, you are giving us permission to contact you in the future about the studies or research projects for which you may be eligible.

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