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208-497-0600

clinical research prime

Adult High Risk RSV

18 years or older
Participants will receive study related treatment at no cost and will be compensated for time and travel

Patient Info *

First

Last

Date of Birth *

Phone *

Email *

Do you have any of the following? *

Moderate or severe COPD with documented history of high exacerbation risk in the last year
Asthma that has required systemic corticosteroid treatment/hospital visit in the last year
Coronary artery disease requiring medication
Bronchiectasis
Congestive heart failure
Interstitial lung disease
Pulmonary hypertension
N/A

Preferred Language

Please review my questions and contact me with further information for this study. *

I Agree

Maternal RSV

15 month duration
Participants will receive study related prevention at no cost and will be compensated for time and travel

Patient Info *

First

Last

Date of Birth *

Phone *

Email *

Are you between 28 and 36 weeks of gestational age? *

Have you had more that 5 pregnancies? (Including miscarriages, still births, etc.) *

Do you have a BMI of <40 kg? *

Yes
No
Unknown

Preferred Language

Please contact me with further information for this study. *

I Agree

Senior RSV 60+

Men and women 60 years or older
Participants will receive study related treatment at no cost and will be compensated for time and travel

Patient Info *

First

Last

Date of Birth *

Phone *

Email *

Do you have a positive RSV infection confirmed within the last 3 days? *

Are you 60+ years old? *

Preferred Language

Please review my questions and contact me with further information for this study. *

I Agree

IDAHO FALLS

Monday-Thursday 8am-5pm & Friday 8am-2pm

187 East 13th Street
Idaho Falls, ID 83404

Clinical Research Prime is an Affiliate of Mountain View Hospital.

REXBURG

By Appointment Only
420 E 4th N
Rexburg, ID 83440

Call: (208) 497-0600
Text: (208) 508-1467
Fax: (208) 497-0606

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