LE241008 | The Skin Study

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 pregnancy within 12 months of the last study drug administration?

NoYes, I am pregnantYes, I am breastfeedingYes, I am trying to conceive
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, bilateral tubal occlusion etc.) OR same-sex partner(s).
- Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, bilateral tubal ligation, 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.
- 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 from the start of screening and until 180 days after last study drug administration?*

YesNo
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, bilateral tubal occlusion etc.) OR same-sex partner(s).
- Surgical: Sterilization (hysterectomy, bilateral salpingectomy, bilateral oophorectomy, bilateral tubal ligation, 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.
- 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 from the start of screening and until completion of the last visit of the trial?*

YesNo

Health and Medical History
Have you previously had abnormal blood results from a blood test? For example; low iron or high bilirubin?*

YesNo
Please provide information regarding your abnormal blood result:
Do you have any history of cancer (benign or malignant), or are you currently being investigated for this type of condition?*

YesNo
Please list the names of the condition(s) and any medications prescribed for that condition:
Have you recently received any vaccines in the last 3 months or have a vaccination scheduled?*

YesNo
Please list (include dates if possible):
Do you have any history of cardiovascular, neurologic, immune, endocrine, metabolic, renal, hepatic, haematological or pulmonary disease or disorder?*

YesNo
Please list the names of the condition(s) and any medications prescribed for that condition

Contraception

Health and Medical History

Health and Medical History

Health and Medical History

Health and Medical History

Survey Questions