Lower Back Pain While currently taking Pain Medications

In order to qualify for this study, you must have a history of back pain.

TIME AND TRAVEL COMPENSATION $50.00 PER VISIT

All information entered in to this form is confidential and will only be used in the course of qualifying you for the study. If you would rather complete this application by telephone, please call 714-558-2700. Our office is open from 8:30am to 5pm, Pacific Standard Time.

Name*
FirstLast
Date of Birth*

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Home Address*
Street AddressCity

StateZip Code
Cell Phone Number
Home Phone Number
Best Time To Contact You
Email*
Do you suffer from any of the following conditions for current and future study participation?
- Hypertension
- Diabetes
- Osteoarthritis
- Rheumatoid Arthritis
- Knee Pain
- General Pain
- Irritable Bowel Syndrome with Diarrhea
- Low Back Pain while currently on strong Pain Medication(Opioid)
- Constipation Caused by strong Pain Medication(opioid)
Please check all that apply
Message / Describe Your Condition

Clinical Trials in Orange County & Riverside County California

Lower Back Pain While currently taking Pain Medications

Ongoing Studies

Future Studies