10 May Questionnaries Success Form Display

Thank you for answering our questions. Your responses have met the preliminary criteria for the study. You will be contacted by a representative from Simplify Medical to confirm your continued interest and ask permission to send your information to the local Simplify Trial center. At that time, the local site will contact you directly and can tell you more about the study, what is involved, and answer any questions you might have. By speaking with your local study site, you are not under any obligation to join the study. Only your local study site can determine whether or not you may be eligible to join the study.

If you would like a representative from Simplify Medical to contact you, please provide the following information. Someone will then contact you within the next several days. Please note: your contact information will only be shared with your local study center so that they can follow-up with you directly to discuss the study. Your information is not used for any other purpose.

The following items did not validate:
Your Name*
First Name
Last Name
Address*
Street
City
State/Province
ZIP Code
Phone*
Email
Best Time to Contact
* Required Field
No Comments

Post A Comment