Join our research community

Registration Form

Thank you for your interest - you can register with us using the form below. Our team will be in touch with you as soon as your profile matches one of our trials.

First name(Required)

(as shown on identification document e.g. Driver's License, Passport)

Middle name

(as shown on identification document e.g. Driver's License, Passport)

Last name(Required)

(as shown on identification document e.g. Driver's License, Passport)

DOB(Required)

Biological sex(Required)

Height(Required)

in cms

Weight(Required)

in kgs

Ethnicity(Required)

Why do we need this information? We are required to follow FDA guidance on the collection of Race and Ethnicity Data in our Clinical trials.

Which region do you currently live in?(Required)

Have you been vaccinated against Covid-19?(Required)

Contact Details

Mobile Phone(Required)

Home Phone

Email(Required)

Trials Interested

Preferred Location(Required)

Trials Interested (Optional)

Medical & Demographic Details

Are you currently on any medication?(Required)

If Yes, please select the Medications(Required)

If Other, please specify(Required)

Have you ever had an allergic reaction to any drug or food?(Required)

If Yes, please specify(Required)

Do you have/had any Medical Conditions?(Required)

If Yes, please select the Medical conditions(Required)

If Other, please specify(Required)

Smoking/Vaping history(Required)

Marketing Question

How did you hear about us?(Required)

Privacy Policy

I understand that by submitting this form, NZCR will hold the information above in a database. All information provided is confidential and will not be given or sold to any other agency without prior consent. I also understand that by submitting this form, I will be receiving emails, texts or calls about potential studies which I can unsubscribe from at any time. For more information, please refer to the Privacy Policy

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Registration Form

Contact Details

Trials Interested

Medical & Demographic Details

Marketing Question

Privacy Policy

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