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Research is what keeps our physicians on the leading edge of scientific advancements in both cosmetic and medical dermatology. We frequently recruit volunteers to participate in research studies involving a variety of conditions, including:

• Forehead and facial lines
• Volume loss and anti-aging
• Skin tightening and body contouring
• Skin cancer and precancerous lesions
• Chronic skin conditions: psoriasis, eczema, rosacea, acne

We are now recruiting for  2019 research studies.

To find out if you qualify, please complete the form below. Your information will be kept strictly confidential and will only be used in conjunction with recruitment and pre-screening for these studies.

Qualified applicants will be contacted directly as opportunities become available.

NAME *

PHONE *

EMAIL *

ADDRESS

CITY

STATE / PROVINCE / REGION

POSTAL / ZIP CODE

COUNTRY
CanadaUnited States

1. Are you a male or female 18 years of age or older?
   YesNo
2. Are you a female who is pregnant or breast feeding?
   YesNo
3. In the last 12 months have you had Botox treatment in the crow’s feet area or below?
   YesNo
4. In the last 12 months have you had any soft tissue non-permanent fillers in cheeks or lower face (e.g. Restylane or Juvederm)?
   YesNo
5. In the last 12 months have you taken any oral retinoid (e.g. Accutane)?
   YesNo
6. In the last 6 months have you had any medium to deep depth facial chemical peels, skin tightening (e.g. Thermage), and/or laser resurfacing of the cheeks or lower face?
   YesNo
7. Have you ever had any cosmetic facial surgery?
   YesNo
8. Are you scheduled to undergo any type of medical or cosmetic surgery facial surgery in the next 9 months?
   YesNo
9. Do you have a history of facial nerve palsy?
   YesNo
10. Do you have any uncontrolled systemic disease?
    YesNo
11. Are you currently taking any type immunosuppressive medication or systemic steroids?
    YesNo
12. Please list any allergies you may have.
    
13. Please list all medications you are currently taking, including dose, indication and regimen.
    
14. Are you available for appointments Monday to Friday between 9-5?
    YesNo
15. Do you plan on being out of the country for more than 4 weeks in the next 9 months?
    YesNo
16. Are you currently part of any other investigational study?
    YesNo
17. How would you best describe your complexion/ skin type:
    Fair - Never tansFair/Medium - Tans with difficultyMedium – Tans with easeMedium/Dark- Tans with ease, very rarely burnsDark - Never burns

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