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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
  • Preferred study duration (select all that apply):*
  • Please select your country of birth:*

  • 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. 

  • 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 currently pregnant or breastfeeding, or are you planning to conceive or breastfeed during the trial?*

  • To protect your health and the integrity of our research, we require effective contraception options during the trial. This ensures the medication doesn't affect a potential pregnancy. 
    There are several reliable contraception methods to choose from. Please consult with your GP for personalised advice prior to screening. The decision to commence any form of contraception should be a decision between you and your GP

    Effective Options:

      • Combined approach: The female using a birth control method (hormonal pill (EXCLUDING progesterone-pill)/implant, IUD, etc.) and the male partner(s) using a condom OR same-sex partner(s).
      • Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, vasectomy) for you or your partner(s).
      • Abstinence: Not sexually active, by choice, with anyone from the opposite sex for at least 2 months before and after the study.
      • Post-menopausal (no menstrual periods for at least 1 year).
         

    For your information, these methods are not considered reliable during the study:

      • Relying solely on your partner's condom use
      • Withdrawal method of contraception
      • Emergency contraception ("morning after pill")
  • Are you willing to follow one of the following effective contraception methods from 28 days prior to dosing and for a minimum of 6 months after dosing.*

  • To protect your health and the integrity of our research, we require effective contraception options during the trial. This ensures the medication doesn't affect a potential pregnancy. 
    There are several reliable contraception methods to choose from. While these methods are effective, consulting your GP for personalised advice before screening is encouraged.

    Effective Options:

    • Combined approach: The male partner(s) using a condom and the female using a birth control method (hormonal pill/implant, IUD, etc.) OR same-sex partner(s).
    • Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, tubal ligation, tubal occlusion, vasectomy) for you or your partner(s). [delete if not relevant]
    • Abstinence: Not sexually active, by choice, with anyone from the opposite sex for at least 2 months before and after the study.
    • Partner is post-menopausal (no menstrual periods for at least 1 year).

    For your information, these methods are not considered reliable during the study:

    • Relying solely on your partner's condom use
    • Withdrawal method of contraception
    • Emergency contraception ("morning after pill")
  • Are you willing to follow one of the following effective contraception methods while participating in the trial from xxx days prior to /  the start of this trial, throughout the trial, and for a minimum of xxx days after completing the trial? [delete if not relevant]

  • Health and Medical History

  • Are you currently taking any medications, vitamins, or supplements, including prescription and over-the-counter options, or those used as needed (e.g., inhalers, iron supplements)?*
  • Have you taken prescribed medication that you have ceased in the last 30 days?*
  • Do you have any current medical conditions? This may include any conditions that previously required hospital admission, surgery, regular medication, regular blood tests or specialist appointments.*
  • Are you a smoker, or have you used tobacco or nicotine-containing products including vaping, shisha, patches and gum within the last 12 months?*
  • Have you used illicit drugs in the last 6 months, IV recreational drug use in the last 2 years, or have you ever been diagnosed with a substance abuse disorder?*

  • Health and Medical History

  • Do you have any history of HIV, Hepatitis B or Hepatitis C?*
  • Have you ever undergone surgery, or do you have planned surgery?*
  • Do you have any current allergies or intolerances, and have you had any allergies or intolerances in the past (i.e. during childhood?)*
  • Do you have any history of neurologic, immune, cardiac or gastrointestinal disorders?*
  • Do you have any mental health conditions or have you had a mental health condition in the last 12 months?*

  • Health and Medical History

  • Have you previously had abnormal blood results from a blood test? For example; low iron or high bilirubin?*
  • Do you have any history of cancer (benign or malignant), or are you currently being investigated for this type of condition?*
  • Have you recently received any vaccines in the last 30 days or do you have a vaccination scheduled?*
  • Have you had a gastric band, gastric sleeve or gastric bypass procedure? [Delete question if not relevant]
  • Have you participated in any clinical study where you received an experimental medication or device within the last 30 days?*
  • Have you donated any blood products or had significant blood loss in the last 2 months?*

  • Health and Medical History

  • Have you had any symptoms of acute respiratory illness (e.g cough, shortness of breath, sore throat, fatigue, loss of smell, fever in the last 2 weeks?*
  • Have you participated in the previous COVID-19 Antibody (LE230204) Study at Linear?*
  • Have you received immunoglobulin or blood products (e.g. plasma, platelets, packed red cells, cryo, granulocytes) within the past 6 months?*
  • Are you willing to avoid strenuous exercise for 48 hours prior to check-in and follow up appointments?*

  • Survey Questions

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