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208-497-0600

clinical research prime

Healthy Women RSV

6 Week Duration
Women 18-49
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 *

Do you have an autoimmune disorder? *

Have you received a previous RSV vaccine of any type? *

Are you pregnant or breastfeeding? *

Preferred Language

Please 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

Intranasal RSV

8-24 months of age
1 year duration
Participants will receive study related treatment at no cost and will be compensated for time and travel

Patient Info *

First

Last

Date of Birth *

Parent/Guardian Info *

First

Last

Phone *

Email *

Has child has Covid, RSV or the flu in the last 3 months? *

Does child have a history of wheezing, or needing oxygen use? *

How many weeks was child born at? *

Preferred Language

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

I Agree

Pediatric RSV

6 months – <22 months of age
5-7 site visits
Participants will receive study related treatment at no cost and will be compensated for time and travel

Patient Info *

First

Last

Date of Birth *

Parent/Guardian Info *

First

Last

Phone *

Email *

Was your child born after 37 weeks gestation age? *

Is your child living with someone who is on immunotherapy? *

Has the mother received an RSV vaccine while pregnant? *

Yes
No
Unknown

Has your child received any vaccinations in the last 28 days? *

Has your child received an RSV vaccine within the last 6 months? *

Preferred Language

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

I Agree

Infant RSV

8-12 months of age
8 site visits
Participants will receive study related treatment at no cost and will be compensated for time and travel

Patient Info *

First

Last

Date of Birth *

Parent/Guardian Info *

First

Last

Phone *

Email *

Did mother receive an RSV vaccine while pregnant? *

Was child born at 37 weeks or older? *

Has child received any vaccines within the last 14 days? *

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

REXBURG

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

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

SOCIAL MEDIA