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  • Nice to meet you, {name}!

    Your responses will be kept confidential between you and the Linear team in line with our privacy policy. Please continue to check your eligibility to participate in one of our studies in Perth, Western Australia!

  • Birth Date*
     - -
  • Biological Sex at Birth*
  • Preferred Pronouns*
  • Format: 0000000000.
  • Date
     - -
    2 digit day, 2 digit month, 4 digit year

  • BMI and Ethnicity

  • The combination of your weight and height determines your BMI (body-mass index)

    Each clinical trial has a "safe range" for participation based on BMI. A BMI that excludes you from a particular clinical trial may make you an ideal candidate for a different one. 

  • Please describe your race/ethnicity (check all that apply)*

  • Contraception

  • Now, we'll ask you some basic questions about your medical history and lifestyle.

    Your health, privacy, and safety are of the utmost importance to Linear, and your accuracy in answering helps us determine your eligbility for this trial or others.

    We ask that you answer to the best of your ability as some health and lifestyle factors can affect the research outcomes and alter your risk profile for participation.

    Honest answers are important.

  • Are you pregnant, breastfeeding, or trying to conceive?
  • Please select which of the following birth control methods you would be willing to use: (Please note that hormonal contraception (e.g. the pill or mirena) is not an accepted contraception method for this trial and will exclude you from the study)
  • Please select which of the following applies to YOUR MALE PARTNER:
  • Please select which of the following birth control methods you would be willing to use:
  • Please select which of the following applies to YOUR FEMALE PARTNER:

  • Health and Medical History

  • Do you have any current allergies or intolerances, and have you had any allergies or intolerances in the past (i.e. during childhood?)*
  • Are you currently taking any prescribed or non-prescribed medications, including vitamins, protein powder or minerals?*
  • Have you taken prescribed medication that you have ceased in the last 12 months?*
  • Have you recently received any vaccines in the last 30 days, or do you have a vaccination scheduled?*
  • Have you donated any blood products or had significant blood loss in the last 30 days?*
  • Have you ever undergone surgery, or do you have planned surgery?*
  • Do you have any current medical conditions OR have you had any past medical conditions?*
  • Have you previously had abnormal blood results from a blood test? For example; low iron or high bilirubin?
  • Have you participated in any clinical study where you received an experimental medication or device within the last 30 days?*

  • Health and Medical History

  • Do you currently use or have used in the last 3 months any nicotine-containing products (i.e. cigarettes, cigars, tobacco, vaping)?*
  • Have you used illicit drugs in the last 6 months, or have you ever been diagnosed with a substance abuse disorder?*
  • Do you have any history of HIV, Hepatitis B or Hepatitis C?

  • Health and Medical History

  • Do you have any history of cancer (benign or malignant), or are you currently being investigated for this type of condition?*
  • Do you have any history of cardiovascular, gastrointestinal, neurological, psychiatric or any other major diseases?*
  • Do you have any history of thyroid or parathyroid disorders or surgeries?*

  • Health and Medical History

  • Do you have any history of epileptic seizure or any recent history of concussion or loss of consciousness in the last 6 months?
  • Are you willing to avoid consuming grapefruit, pomelo, grapefruit juice or pomelo juice 48 hours prior to check-in until the end of the study?*
  • Are you willing to avoid consuming alcohol, caffeine and xanthine (coffee, tea, chocolate etc), smoking and the use of any nicotine/tobacco products from 48 hours prior to dosing until the end of the study?*

  • Previous Trial

  • What best fits your current lifestyle?
  • Should be Empty: