Thank-you for your interest in Apex Eye’s research studies. Completing this on-line participant enrollment form does not obligate you to participate in our studies. It provides our research team with information that helps them determine the types of future studies that might be right for you. By having this information, we can communicate with you more effectively regarding participation in specific future studies.

We value your interest and respect your privacy. This information will not be shared with other organizations or companies. We respect your privacy.

First Name*

Last Name*

Address*

City*

State

Zip*

Your Email*

Home Phone:*

Cell Phone:*

Gender*

Date of Birth*

Check Any Conditions that Apply to You*

Check if you are an Apex Eye patient*

Most convenient Apex Eye Location*

This information in no way obligates participation in a study. We respect your privacy. All information will be kept confidential, will only be used by only by Apex Eye, and will be covered by rules outlined in HIPPA and FDA Protection of Human Subjects Regulations. Information may be changed or deleted by emailing ClinicalStudies@ApexEye.com.

Please enter the text below:
captcha

*Required