Memory Loss

Enrolling Now

If you are noticing changes in your memory or ability to think clearly, you may pre-qualify for one of our clinical research studies.

All study-related care will be provided at no cost to you. Health insurance is not required.

When it comes to questions about your health, you’ve always sought out the answers. Why stop now?

Complete the form below to learn more about our clinical trials.

If you are interested in participating in this study, please complete the following preliminary qualification form.

We will follow-up with you after we have received your submission.

Study Information
Study Name*
Contact Information
Name*
First Middle Last
Date of Birth (ex 01-DEC-1963)
Phone*
E-mail*
Zip Code*
Do you or a family member have a history of memory loss?*
- Yes
- No
- Unsure
Are you completing this form on behalf of yourself or someone else?*
- Myself
- Someone else
How did you find us?
I agree to Headlands Research's Privacy Policy.*
- Yes
I agree to receive email and automated text messages. Msg & data rates may apply.*
- Yes
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Study Information